Audit Review Table - NM Human Services · 2014-01-08 · Molina Healthcare of New Mexico (Org ID:...

Measure/Data Element Report Measure

Benefit Offered

Rotated Measure

Adult BMI Assessment (aba) YWeight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (wcc)

Y

BMI PercentileCounseling for Nutrition

Counseling for Physical ActivityChildhood Immunization Status (cis) Y

DTaPIPV

MMRHiB

Hepatitis BVZV

Pneumococcal ConjugateHepatitis A

RotavirusInfluenza

Combination #2Combination #3Combination #4Combination #5Combination #6Combination #7Combination #8Combination #9

Combination #10Immunizations for Adolescents (ima) Y

MeningococcalTdap/Td

Combination #1Lead Screening in Children (lsc) YBreast Cancer Screening (bcs) YCervical Cancer Screening (ccs) Y NChlamydia Screening in Women (chl) Y

16-20 Years21-24 Years

Total

Appropriate Testing for Children with Pharyngitis (cwp) Y Y

Appropriate Treatment for Children With URI (uri) Y YAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis (aab) Y Y

Use of Spirometry Testing in the Assessment and Diagnosis of COPD (spr) Y

Pharmacotherapy Management of COPD Exacerbation (pce) Y Y

Systemic CorticosteroidBronchodilator

Audit Review TableMolina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj

The Auditor lock has been applied to this

Effectiveness of Care: Prevention and Screening

Effectiveness of Care: Respiratory Conditions

Use of Appropriate Medications for People With Asthma (asm) Y Y


Total

Cholesterol Management for Patients With Cardiovascular Conditions (cmc) Y

LDL-C Screening PerformedLDL-C Control (<100 mg/dL)

Controlling High Blood Pressure (cbp) Y YPersistence of Beta-Blocker Treatment After a Heart Attack (pbh) Y Y

Comprehensive Diabetes Care (cdc) YHemoglobin A1c (HbA1c) Testing

HbA1c Poor Control (>9.0%)HbA1c Control (<8.0%)HbA1c Control (<7.0%)

Eye Exam (Retinal) PerformedLDL-C Screening PerformedLDL-C Control (<100 mg/dL)

Medical Attention for NephropathyBlood Pressure Control (<130/80 mm Hg)Blood Pressure Control (<140/90 mm Hg)

Disease Modifying Anti-Rheumatic Drug therapy in Rheumatoid Arthritis (art) Y Y

Use of Imaging Studies for Low Back Pain (lbp) Y

Antidepressant Medication Management (amm) Y NEffective Acute Phase Treatment

Effective Continuation Phase Treatment

Follow-Up Care for Children Prescribed ADHD Medication (add) Y Y

Initiation PhaseContinuation and Maintenance (C&M) Phase

Follow-Up After Hospitalization for Mental Illness (fuh) Y N

30-Day Follow-Up7-Day Follow-Up

Annual Monitoring for Patients on Persistent Medications (mpm) Y Y

ACE Inhibitors or ARBsDigoxin

DiureticsAnticonvulsants

Total

Adults' Access to Preventive/Ambulatory Health Services (aap) Y


65+ Years

Effectiveness of Care: Cardiovascular

Effectiveness of Care: Diabetes

Effectiveness of Care: Musculoskeletal

Effectiveness of Care: Behavioral Health

Effectiveness of Care: Medication Management

Access/Availability of Care

TotalChildren and Adolescents' Access to Primary Care Practitioners (cap) Y

12-24 Months25 Months - 6 Years


Annual Dental Visit (adv) Y Y2-3 Years4-6 Years

7-10 Years11-14 Years15-18 Years19-21 Years

TotalInitiation and Engagement of AOD Dependence Treatment (iet) Y N

Initiation of AOD Treatment: 13-17 YearsEngagement of AOD Treatment: 13-17 Years

Initiation of AOD Treatment: 18+ YearsEngagement of AOD Treatment: 18+ Years

Initiation of AOD Treatment: TotalEngagement of AOD Treatment: Total

Prenatal and Postpartum Care (ppc) Y YTimeliness of Prenatal Care

Postpartum CareCall Answer Timeliness (cat) YCall Abandonment (cab) Y

Frequency of Ongoing Prenatal Care (fpc) Y N<21 Percent

21-40 Percent41-60 Percent61-80 Percent

81+ PercentWell-Child Visits in the First 15 Months of Life (w15) Y

0 Visits1 Visit

2 Visits3 Visits4 Visits5 Visits

6+ Visits

Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (w34) Y

Adolescent Well-Care Visits (awc) YFrequency of Selected Procedures (fsp) YAmbulatory Care: Total (amba) YAmbulatory Care: Dual Eligibles (ambb) NAmbulatory Care: Disabled (ambc) NAmbulatory Care: Other (ambd) NInpatient Utilization--General Hospital/Acute Care: Total (ipua) Y

Use of Services

Inpatient Utilization--General Hospital/Acute Care: Dual Eligibles (ipub) N

Inpatient Utilization--General Hospital/Acute Care: Disabled (ipuc) N

Inpatient Utilization--General Hospital/Acute Care: Other (ipud) N

Inpatient Utilization--Nonacute Care: Total (nona) YInpatient Utilization--Nonacute Care: Dual Eligibles (nonb) N

Inpatient Utilization--Nonacute Care: Disabled (nonc) N

Inpatient Utilization--Nonacute Care: Other (nond) NIdentification of Alcohol and Other Drug Services: Total (iada) Y N

Identification of Alcohol and Other Drug Services: Dual Eligibles (iadb) N N

Identification of Alcohol and Other Drug Services: Disabled (iadc) N N

Identification of Alcohol and Other Drug Services: Other (iadd) N N

Mental Health Utilization: Total (mpta) Y NMental Health Utilization: Dual Eligibles (mptb) N NMental Health Utilization: Disabled (mptc) N NMental Health Utilization: Other (mptd) N NAntibiotic Utilization: Total (abxa) Y YAntibiotic Utilization: Dual Eligibles (abxb) N NAntibiotic Utilization: Disabled (abxc) N NAntibiotic Utilization: Other (abxd) N NOutpatient Drug Utilization: Total (orxa) Y YOutpatient Drug Utilization: Dual Eligibles (orxb) N NOutpatient Drug Utilization: Disabled (orxc) N NOutpatient Drug Utilization: Other (orxd) N N

Relative Resource Use for People With Diabetes (rdi) Y

Inpatient Facility: Per Member Per MonthE & M Inpatient: Per Member Per Month

E & M Outpatient: Per Member Per MonthSurgery Inpatient: Per Member Per Month

Surgery Outpatient: Per Member Per MonthPharmacy: Per Member Per Month

Inpatient Facility Discharges per 1,000 Member Years

ED Visits per 1,000 Member YearsRelative Resource Use for People With Asthma (ras) Y Y





ED Visits per 1,000 Member Years

Cost of Care

Relative Resource Use for People With Acute Lower Back Pain (rlb) Y





ED Visits per 1,000 Member YearsMRIs per 1,000 Member Years

Relative Resource Use for People With Cardiovascular Conditions (rca) Y





ED Visits per 1,000 Member YearsRelative Resource Use for People With Hypertension (rhy) Y





ED Visits per 1,000 Member YearsRelative Resource Use for People With COPD (rco) Y





ED Visits per 1,000 Member Years

Board Certification (bcr) YEnrollment by Product Line: Total (enpa) YEnrollment by Product Line: Dual Eligibles (enpb) NEnrollment by Product Line: Disabled (enpc) NEnrollment by Product Line: Other (enpd) NEnrollment by State (ebs) YRace/Ethnicity Diversity of Membership (rdm) YLanguage Diversity of Membership (ldm) YWeeks of Pregnancy at Time of Enrollment in MCO (wop) Y N

Health Plan Descriptive Information

Total Membership (tlm) YHealth Plan Stability

Rate Reportable Comment

34.22% R Reportable

19.21% R Reportable34.22% R Reportable28.48% R Reportable

80.75% R Reportable90.27% R Reportable91.37% R Reportable95.58% R Reportable89.60% R Reportable90.71% R Reportable77.43% R Reportable35.40% R Reportable66.59% R Reportable33.19% R Reportable74.34% R Reportable68.58% R Reportable30.31% R Reportable52.43% R Reportable27.88% R Reportable24.12% R Reportable13.50% R Reportable23.45% R Reportable11.50% R Reportable

45.70% R Reportable65.56% R Reportable43.93% R Reportable23.01% R Reportable50.78% R Reportable67.79% R Reportable


55.17% R Reportable

82.55% R Reportable

16.14% R Reportable

24.07% R Reportable

63.29% R Reportable87.34% R Reportable

j: None)

submission.



NA R Denominator fewer than 30


NR NR Plan chose not to report58.69% R Reportable74.94% R Reportable33.18% R Reportable72.69% R Reportable34.09% R Reportable57.11% R Reportable

86.67% R Reportable

74.33% R Reportable

NB R Required benefit not offeredNB R Required benefit not offered


NB R Required benefit not offeredNB R Required benefit not offered

87.61% R ReportableNA R Denominator fewer than 30



84.99% R Reportable

97.56% R Reportable89.97% R Reportable93.34% R Reportable92.03% R Reportable

50.32% R Reportable72.53% R Reportable77.65% R Reportable72.19% R Reportable59.71% R Reportable40.32% R Reportable67.28% R Reportable

NB R Required benefit not offeredNB R Required benefit not offeredNB R Required benefit not offeredNB R Required benefit not offeredNB R Required benefit not offeredNB R Required benefit not offered






61.29% R Reportable

52.76% R ReportableR ReportableR Reportable

NRNRNR

R Reportable

NR

NR

NR

R Reportable

NR

NR

NR

R Required benefit not offered

NR

NR

NR

R Required benefit not offeredNRNRNRR Reportable

NRNRNRR Reportable

NRNRNR

$295.35 R Reportable$13.43 R Reportable$74.08 R Reportable$14.82 R Reportable$36.87 R Reportable

$233.64 R Reportable

365.32 R Reportable

1,574.51 R Reportable

$54.83 R Reportable$3.22 R Reportable

$47.72 R Reportable$0.50 R Reportable$9.42 R Reportable


112.44 R Reportable




$26.88 R Reportable

17.24 R Reportable

1,517.24 R Reportable379.31 R Reportable



760.18 R Reportable





126.73 R Reportable




667.19 R Reportable


R ReportableR Reportable

NRNRNRR ReportableR ReportableR Reportable

R Reportable

R Reportable

Data Element Measure Data

Measurement year 2009Data collection methodology

(administrative or hybrid) H

Eligible population 5662Number of numerator events by

administrative data in eligible population (before exclusions)

147

Current year's administrative rate (before exclusions) 2.60%

Minimum required sample size (MRSS) or other sample size 411

Oversampling rate 0.1Final sample size (FSS) 453

Number of numerator events by administrative data in FSS 7

Administrative rate on FSS 1.55%Number of original sample records

excluded because of valid data errors 0

Number of administrative data records excluded 0

Number of medical records excluded 0Number of employee/dependent medical

records excluded 0

Records added from the oversample list 0Denominator 453

Numerator events by administrative data 7

Numerator events by medical records 148Reported rate 34.22%

Lower 95% confidence interval 29.74%Upper 95% confidence interval 38.70%

Adult BMI Assessment (ABA)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

3-11 years 12-17 years Total 3-11 years 12-17 yearsMeasurement year

Data collection methodology (administrative or hybrid)

Eligible population 20099 9360 29,459 20099 9360Number of numerator events by


68 77 145 67 65

Current year's administrative rate (before exclusions) 0.34% 0.82% 0.49% 0.33% 0.69%

Minimum required sample size (MRSS) or other sample sizeOversampling rateFinal sample size

Number of numerator events by administrative data in FSS 2 0 2 0 3

Administrative rate on FSS 0.44% 0.00% 0.44% 0.00% 0.66%Number of original sample records

excluded because of valid data errorsNumber of administrative data records

excludedNumber of medical records excluded

Number of employee/dependent medical records excluded

Records added from the oversample listDenominator 317 136 453 317 136

Numerator events by administrative data 2 0 2 0 3

Numerator events by medical records 54 31 85 109 43Reported rate 17.67% 22.79% 19.21% 34.38% 33.82%

Lower 95% confidence interval 13.31% 15.38% 15.47% 29.00% 25.50%Upper 95% confidence interval 22.02% 30.21% 22.94% 39.77% 42.14%

Weight Assessment and Counseling for Nutrition and Physical Activity for Childre Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Data Element BMI Percentile Counseling for Nut

2009 2009

H H

411 411

0.1 0.1453 453

0 0

0 0

0 0

0 0

0 0

Total 3-11 years 12-17 years Total

29,459 20099 9360 29,459

132 3 5 8

0.45% 0.01% 0.05% 0.03%

3 0 0 0

0.66% 0.00% 0.00% 0.00%

453 317 136 453

3 0 0 0

152 91 38 12934.22% 28.71% 27.94% 28.48%29.74% 23.57% 20.03% 24.21%38.70% 33.84% 35.85% 32.74%

en/Adolescents (WCC)

rition Counseling for Physical Activity

2009

H

411

0.1453

0

0

0

0

0

Data ElementGeneral Measure

DataDTaP IPV MMR HiB



Eligible population 2615Number of numerator events by admin

data in eligible population (before exclusions)

811 1033 1915 1694

Current year's administrative rate (before exclusions) 31.01% 39.50% 73.23% 64.78%

Minimum required sample size (MRSS) or other sample Size 411

Oversampling rate 0.1Final sample size 453

Number of numerator events by admin data in FSS 336 380 403 421

Administrative rate on FSS 74.17% 83.89% 88.96% 92.94%Number of original records excluded

because of valid data errors 1


Number of medical data records excluded 0

Number of employee/dependent medical records excluded 0


Numerator events by administrative data 336 380 403 421

Number of numerator events by medical records 29 28 10 11

Reported rate 80.75% 90.27% 91.37% 95.58%Lower 95% confidence interval 77.01% 87.42% 88.67% 93.57%Upper 95% confidence interval 84.50% 93.11% 94.07% 97.58%

Childhood Immunization Status (CIS)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Hepatitis B VZVPneumo-

coccal Conjugate

Hepatitis A Rotavirus Influenza Combination 2

Combination 3

711 1900 736 591 594 661 453 391

27.19% 72.66% 28.15% 22.60% 22.72% 25.28% 17.32% 14.95%

372 399 323 149 273 138 293 265

82.12% 88.08% 71.30% 32.89% 60.26% 30.46% 64.68% 58.50%

372 399 323 149 273 138 293 265

33 11 27 11 28 12 43 45

89.60% 90.71% 77.43% 35.40% 66.59% 33.19% 74.34% 68.58%86.68% 87.92% 73.47% 30.88% 62.13% 28.73% 70.20% 64.19%92.53% 93.50% 81.40% 39.92% 71.05% 37.64% 78.47% 72.97%

Combination 4

Combination 5

Combination 6

Combination 7

Combination 8

Combination 9

Combination 10

137 253 157 98 59 119 46

5.24% 9.67% 6.00% 3.75% 2.26% 4.55% 1.76%

110 193 104 83 48 86 37

24.28% 42.60% 22.96% 18.32% 10.60% 18.98% 8.17%

110 193 104 83 48 86 37

27 44 22 26 13 20 15

30.31% 52.43% 27.88% 24.12% 13.50% 23.45% 11.50%25.96% 47.72% 23.63% 20.06% 10.24% 19.43% 8.45%34.66% 57.15% 32.12% 28.17% 16.76% 27.47% 14.56%


Data

Meningococcal Tdap/Td Combinatio

n 1





725 891 602

Current year's administrative rate (before exclusions) 36.69% 45.09% 30.47%

Minimum required sample size (MRSS) or other sample Size 411

Oversampling rate 0.1Final sample size 453

Number of numerator events by admin data in FSS 161 210 141

Administrative rate on FSS 35.54% 46.36% 31.13%Number of original records excluded

because of valid data errors 0





Numerator events by administrative data 161 210 141

Number of numerator events by medical records 46 87 58

Reported rate 45.70% 65.56% 43.93%Lower 95% confidence interval 41.00% 61.08% 39.25%Upper 95% confidence interval 50.39% 70.05% 48.61%

Immunizations for Adolescents (IMA)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Data Elements which do not apply to the selected data collection methodology

will not appear

General Measure

DataMeasurement year 2009

Data collection methodology (administrative or hybrid) H



583














Lead Screening in Children (LSC)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Lead Screening in Children



Data collection methodology (administrative) A

Eligible population 1343


Reported rate 50.78%Lower 95% confidence interval 48.07%Upper 95% confidence interval 53.49%

Breast Cancer Screening (BCS)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)






3119














Cervical Cancer Screening (CCS)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)


Data16-20 years 21-24 years Total


(administrative) A

Eligible population 1840 881 2,721

Numerator events by administrative data 852 488 1,340


Chlamydia Screening in Women (CHL)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)



(administrative) A




Appropriate Testing for Children with Pharyngitis (CWP)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)



(administrative) A




Appropriate Treatment for Children With URI (URI)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)



(administrative) A

Eligible population 316Total numerator events by administrative

data 265


Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)



(administrative) A




Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Data Elements Measure Data

Systemic corticostero

id

Bronchodilator


(administrative) A

Eligible population 79Exclusions based on direct transfers to

another facility* 5

Exclusions based on readmissions* 30

Numerator events by administrative data 50 69

Reported rate 63.29% 87.34%Lower 95% confidence interval 52.03% 79.38%Upper 95% confidence interval 74.55% 95.31%

Pharmacotherapy Management of COPD Exacerbation (PCE)

Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Pharmacotherapy Management of COPD Exacerbation

* Reporting this additional data element is optional in IDSS.


Data5-11 years 12-50 years Total


(administrative) A

Eligible population 448 501 949

Numerator events by administrative data 403 415 818


Use of Appropriate Medications for People With Asthma (ASM)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)


Data

LDL-C Screening

LDL-C level <100 mg/dL





89 11

Current year's administrative rate (before exclusions) 76.72% 9.48%



Number of numerator events by administrative data in FSS 89 11

Administrative rate on FSS 76.72% 9.48%Number of original sample records





Numerator events by medical records 3 35Reported rate 79.31% 39.66%

Lower 95% confidence interval 71.51% 30.32%Upper 95% confidence interval 87.11% 48.99%

Cholesterol Management for Patients With Cardiovascular Conditions (CMC)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)



Data collection methodology (hybrid) HEligible population 1238

Number of numerator events by administrative data in eligible population

(before exclusions)0







Number of records excluded because of false positive diagnoses 6








Controlling High Blood Pressure (CBP)




(administrative) A



Reported rate NALower 95% confidence interval NAUpper 95% confidence interval NA

Persistence of Beta-Blocker Treatment After a Heart Attack (PBH)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Data Element HbA1c Testing

HbA1c Poor Control (>9.0%)

HbA1c Control (<8.0%)

HbA1c Control

(<7.0%) for a Selected

Population

Eye Exam

Measurement year 2009 2009 2009 NR 2009Data collection methodology

(administrative or hybrid) H H H NR H

Eligible population 985 985 985 NR 985Number of numerator events by


764 846 113 NR 435

Current year's administrative rate (before exclusions) 77.56% 85.89% 11.47% NR 44.16%

Minimum required sample size (MRSS) or other sample size 411 411 411 NR 411

Oversampling rate 0.1 0.1 0.1 NR 0.1Final sample size (FSS) 453 453 453 NR 453

Number of numerator events by administrative data in FSS 359 395 47 NR 209

Administrative rate on FSS 79.25% 87.20% 10.38% NR 46.14%Number of original sample records

excluded because of valid data errors 10 10 10 NR 10

Number of administrative data records excluded 0 0 0 NR 0

Number of medical data records excluded 0 0 0 NR 0

Number of administrative HbA1C <7 required exclusions NR

Number of hybrid HbA1C <7 required exclusions NR

Number of employee/dependent medical records excluded 0 0 0 NR 0

Records added from the oversample list 0 0 0 NR 0Denominator 443 443 443 NR 443

Numerator events by administrative data 359 178 47 NR 209

Numerator events by medical records 18 42 134 NR 51Reported rate 85.10% 49.66% 40.86% NR 58.69%

Lower 95% confidence interval 81.67% 44.89% 36.17% NR 53.99%Upper 95% confidence interval 88.53% 54.43% 45.55% NR 63.39%

Comprehensive Diabetes Care (CDC)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

LDL-C Screening

LDL-C Level <100 mg/dL

Medical Attention for Nephropath

y

Blood Pressure

Controlled <130/80 mm

Hg

Blood Pressure

Controlled <140/90 mm

Hg2009 2009 2009 2009 2009

H H H H H

985 985 985 985 985

681 115 651 2 5

69.14% 11.68% 66.09% 0.20% 0.51%

411 411 411 411 411

0.1 0.1 0.1 0.1 0.1453 453 453 453 453

320 57 301 1 1

70.64% 12.58% 66.45% 0.22% 0.22%

10 10 10 10 10

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0443 443 443 443 443

320 57 301 1 1

12 90 21 150 25274.94% 33.18% 72.69% 34.09% 57.11%70.80% 28.69% 68.42% 29.56% 52.39%79.09% 37.68% 76.95% 38.61% 61.83%



(administrative) A




Disease Modifying Anti-Rheumatic Drug therapy in Rheumatoid Arthritis (ART)




(administrative) A



Reported rate 74.33%Lower 95% confidence Interval 70.00%Upper 95% confidence Interval 78.67%

Use of Imaging Studies for Low Back Pain (LBP)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)


Data

Effective Acute Phase

Treatment

Effective Continuatio

n Phase Treatment

Measurement year NRData collection methodology

(administrative) NR

Eligible population NR

Numerator events by administrative data NR NR

Reported rate NR NRLower 95% confidence interval NR NRUpper 95% confidence interval NR NR

Antidepressant Medication Management (AMM)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)


Data

Initiation Phase

Continuation and

Maintenance Phase


(administrative) A

Eligible population 365 65


Reported rate 35.89% 49.23%Lower 95% confidence interval 30.83% 36.31%Upper 95% confidence interval 40.95% 62.15%

Follow-Up Care for Children Prescribed ADHD Medication (ADD)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)


Data

30-day follow-up

7-day follow-up

Measurement year NRData collection methodology

(administrative) NR

Eligible population NR

Numerator events by administrative data NR NR

Reported rate NR NRLower 95% confidence interval NR NRUpper 95% confidence interval NR NR

Follow-Up After Hospitalization for Mental Illness (FUH)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)


Data

ACE Inhibitors or

ARBsDigoxin Diuretics Anti-

convulsants


(administrative) A

Eligible population 654 17 473 238


Reported rate 87.61% NA 87.10% 72.69%Lower 95% confidence interval 85.01% NA 83.98% 66.82%Upper 95% confidence interval 90.22% NA 90.23% 78.56%

Annual Monitoring for Patients on Persistent Medications (MPM)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Total

1,382

1,171

84.73%82.80%86.66%


Data20-44 years 45-64 years 65+ years Total


(administrative) A

Eligible population 6051 2406 140 8,597

Numerator events by administrative data 5110 2076 121 7,307


Adults' Access to Preventive/Ambulatory Health Services (AAP)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)


Data

12-24 months

25 months - 6 years 7-11 years 12-19 years


(administrative) A




Children and Adolescents' Access to Primary Care Practitioners (CAP)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Data Element Measure Data 2-3 Years 4-6 Years 7-10 Years 11-14 Years


(administrative) A




Annual Dental Visit (ADV)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

15-18 Years 19-21 Years Total

7083 1049 40,781

4229 423 27,436

59.71% 40.32% 67.28%58.56% 37.31% 66.82%60.86% 43.34% 67.73%

Initiation of AOD

Treatment

Engagement of AOD

Treatment

Initiation of AOD

Treatment

Engagement of AOD

TreatmentMeasurement year NR

Data collection methodology (administrative) NR

Eligible population

Numerator events by administrative data NR NR NR NR

Reported rate NR NR NR NRLower 95% confidence interval NR NR NR NRUpper 95% confidence interval NR NR NR NR

Initiation and Engagement of AOD Dependence Treatment (IET)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Data ElementsGeneral Measure

Data

13-17 years 18+ years

NR NR

Initiation of AOD

Treatment

Engagement of AOD

Treatment

NR NR

NR NRNR NRNR NR

Total

NR

Data ElementTimeliness of Prenatal

Care

Postpartum Care

Measurement year 2008 2009Data collection methodology

(administrative or hybrid) H H

Eligible population 2342 2232Number of numerator events by


907 784

Current year's administrative rate (before exclusions) 38.73% 35.13%

Minimum required sample size (MRSS) or other sample size 411 411

Oversampling rate 0.1 0.1Final sample size (FSS) 453 453

Number of numerator events by administrative data in FSS 177 163

Administrative rate on FSS 39.07% 35.98%Number of original sample records

excluded because of valid data errors 1 3

Number of employee/dependent medical records excluded 0 0

Records added from the oversample list 0 0Denominator 452 450


Numerator events by medical records 199 93Reported rate 83.19% 56.89%

Lower 95% confidence interval 79.63% 52.20%Upper 95% confidence interval 86.74% 61.58%

Prenatal and Postpartum Care (PPC)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)



(administrative) A




Call Answer Timeliness (CAT)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)



(administrative) A




Call Abandonment (CAB)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)


Data<21 Percent 21-40

Percent41-60

Percent61-80

Percent





1534 362 121 102




Number of numerator events by administrative data in FSS 300 74 28 25

Administrative rate on FSS 66.23% 16.34% 6.18% 5.52%Number of original sample records





Numerator events by medical records 4 11 19 45Reported rate 16.00% 8.67% 5.78% 13.78%

Lower 95% confidence interval 12.50% 5.96% 3.51% 10.48%Upper 95% confidence interval 19.50% 11.38% 8.04% 17.07%

Frequency of Ongoing Prenatal Care (FPC)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

81+ Percent

113

5.06%

26

5.74%

31

22055.78%51.08%60.48%

Data Element Measure Data 0 visits 1 visit 2 visits 3 visits





44 76 124 189




Number of numerator events by administrative data in FSS 5 18 22 34

Administrative rate on FSS 1.10% 3.97% 4.86% 7.51%Number of original sample records





Numerator events by medical records 0 0 5 4Reported rate 0.88% 2.43% 4.64% 4.86%

Lower 95% confidence interval 0.00% 0.90% 2.59% 2.77%Upper 95% confidence interval 1.85% 3.96% 6.68% 6.95%

Well-Child Visits in the First 15 Months of Life (W15)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

4 visits 5 visits 6 or more visits

346 500 1024

15.02% 21.71% 44.46%

67 95 212

14.79% 20.97% 46.80%

43 61 212

7 15 5711.04% 16.78% 59.38%8.04% 13.23% 54.75%

14.03% 20.33% 64.01%






6402












Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34)







5403












Adolescent Well-Care Visits (AWC)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Age Male Female Total0-4 230,2140-9 416,377

5-19 445,33410-19 259,17115-44 150,10120-44 25,088 91,28930-64 29,48745-64 15,953 20,258

Procedure Age Sex Number of Procedures

Procedures / 1,000

Member Months

0-4 510 2.225-19 145 0.330-9 299 0.72

10-19 141 0.5415-44 28 0.1945-64 3 0.1515-44 40 0.2745-64 9 0.4415-44 32 0.2145-64 3 0.1530-64 Male 3 0.1015-44 3 0.0245-64 4 0.2030-64 Male 9 0.3115-44 167 1.1145-64 15 0.74

Male 4 0.16Female 17 0.19

Male 14 0.88Female 24 1.18

15-44 2 0.0145-64 4 0.2015-44 17 0.1145-64 7 0.35

Frequency of Selected Procedures (FSP)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Myringotomy Male & Female

Tonsillectomy Male & Female

Dilation & Curettage Female

Hysterectomy, Abdominal Female

Hysterectomy,Vaginal Female

Mastectomy Female

Lumpectomy Female

Cholecystectomy,Open Female

Cholecystectomy,Closed (laparoscopic) Female

Back Surgery20-44

45-64

Age Member Months

<1 49,5641-9 366,813

10-19 259,17120-44 116,37745-64 36,21165-74 1,46675-84 18685+ 39

Unknown 0Total 829,827

VisitsVisits/ 1,000

Member Months

VisitsVisits/ 1,000

Member Months

Procedures

<1 40710 821.36 4410 88.98 1691-9 119834 326.69 15986 43.58 1522

10-19 72550 279.93 9599 37.04 103720-44 51727 444.48 9347 80.32 207045-64 25916 715.69 2488 68.71 85765-74 1242 847.20 67 45.70 5575-84 123 661.29 7 37.63 785+ 32 820.51 1 25.64 1

Unknown 0 0 0Total 312,134 376.14 41,905 50.50 5,718

Ambulatory Care: Total (AMBA)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Age

Outpatient Visits ED Visits Ambu Surgery/Pr

Procedures/ 1,000

Member Months

StaysStays/ 1,000

Member Months

3.41 25 0.504.15 41 0.114.00 308 1.19

17.79 823 7.0723.67 12 0.3337.52 0 0.0037.63 0 0.0025.64 0 0.00

06.89 1,209 1.46

latory rocedures

Observation Room Stays Resulting in Discharge

Age Member Months

<1 NR1-9 NR

10-19 NR20-44 NR45-64 NR65-74 NR75-84 NR85+ NR

Unknown NRTotal NR

VisitsVisits/ 1,000

Member Months

VisitsVisits/ 1,000

Member Months

Procedures

<1 NR NR NR NR NR1-9 NR NR NR NR NR

10-19 NR NR NR NR NR20-44 NR NR NR NR NR45-64 NR NR NR NR NR65-74 NR NR NR NR NR75-84 NR NR NR NR NR85+ NR NR NR NR NR

Unknown NR NR NRTotal NR NR NR NR NR

Ambulatory Care: Dual Eligibles (AMBB)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Age


Procedures/ 1,000

Member Months

StaysStays/ 1,000

Member Months

NR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NR

NRNR NR NR

latory rocedures


Age Member Months

<1 NR1-9 NR

10-19 NR20-44 NR45-64 NR65-74 NR75-84 NR85+ NR

Unknown NRTotal NR

VisitsVisits/ 1,000

Member Months

VisitsVisits/ 1,000

Member Months

Procedures




Ambulatory Care: Disabled (AMBC)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Age


Procedures/ 1,000

Member Months

StaysStays/ 1,000

Member Months


NRNR NR NR

latory rocedures


Age Member Months

<1 NR1-9 NR

10-19 NR20-44 NR45-64 NR65-74 NR75-84 NR85+ NR

Unknown NRTotal NR

VisitsVisits/ 1,000

Member Months

VisitsVisits/ 1,000

Member Months

Procedures




Ambulatory Care: Other (AMBD)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Age


Procedures/ 1,000

Member Months

StaysStays/ 1,000

Member Months


NRNR NR NR

latory rocedures


Age Member Months

<1 49,5641-9 366,813

10-19 259,17120-44 116,37745-64 36,21165-74 1,46675-84 18685+ 39


Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay

<1 620 12.51 2794 56.37 4.511-9 970 2.64 3368 9.18 3.47

10-19 1160 4.48 3768 14.54 3.2520-44 2811 24.15 7933 68.17 2.8245-64 739 20.41 4643 128.22 6.2865-74 27 18.42 176 120.05 6.5275-84 7 37.63 92 494.62 13.1485+ 2 51.28 18 461.54 9.00

Unknown 0 0 NATotal 6,336 7.64 22,792 27.47 3.60

Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay

<1 546 11.02 2157 43.52 3.951-9 760 2.07 2206 6.01 2.90

10-19 283 1.09 1007 3.89 3.5620-44 400 3.44 1622 13.94 4.0645-64 441 12.18 2130 58.82 4.8365-74 16 10.91 76 51.84 4.7575-84 2 10.75 7 37.63 3.5085+ 1 25.64 9 230.77 9.00

Unknown 0 0 NATotal 2,449 2.95 9,214 11.10 3.76

Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay

<1 74 1.49 637 12.85 8.611-9 210 0.57 1162 3.17 5.53

10-19 190 0.73 1196 4.61 6.2920-44 287 2.47 1555 13.36 5.4245-64 295 8.15 2491 68.79 8.44

Inpatient Utilization--General Hospital/Acute Care: Total (IPUA)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Total Inpatient

Medicine

Surgery

65-74 11 7.50 100 68.21 9.0975-84 5 26.88 85 456.99 17.0085+ 1 25.64 9 230.77 9.00

Unknown 0 0 NATotal 1,073 1.29 7,235 8.72 6.74

Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay

10-19 687 2.65 1565 6.04 2.2820-44 2124 18.25 4756 40.87 2.2445-64 3 0.08 22 0.61 7.33

Unknown 0 0 NATotal 2,814 6.83 6,343 15.40 2.25

*The maternity category is calculated using member months for members 10-64 years.

Maternity*

Age Member Months

<1 NR1-9 NR

10-19 NR20-44 NR45-64 NR65-74 NR75-84 NR85+ NR

Unknown NRTotal NR

Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay




Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay




Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay


10-19 NR NR NR NR NR20-44 NR NR NR NR NR45-64 NR NR NR NR NR

Inpatient Utilization--General Hospital/Acute Care: Dual Eligibles (IPUB)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Total Inpatient

Medicine

Surgery

65-74 NR NR NR NR NR75-84 NR NR NR NR NR85+ NR NR NR NR NR


Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay




Maternity*

Age Member Months

<1 NR1-9 NR

10-19 NR20-44 NR45-64 NR65-74 NR75-84 NR85+ NR

Unknown NRTotal NR

Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay




Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay




Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay



Inpatient Utilization--General Hospital/Acute Care: Disabled (IPUC)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Total Inpatient

Medicine

Surgery



Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay




Maternity*

Age Member Months

<1 NR1-9 NR

10-19 NR20-44 NR45-64 NR65-74 NR75-84 NR85+ NR

Unknown NRTotal NR

Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay




Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay




Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay



Inpatient Utilization--General Hospital/Acute Care: Other (IPUD)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Total Inpatient

Medicine

Surgery



Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Members Months

Average Length of

Stay




Maternity*

Age Member Months

<1 49,5641-9 366,813

10-19 259,17120-44 116,37745-64 36,21165-74 1,46675-84 18685+ 39


Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Member Months

Average Length of

Stay

<1 0 0.00 0 0.00 NA1-9 0 0.00 0 0.00 NA

10-19 1 0.00 42 0.16 42.0020-44 7 0.06 88 0.76 12.5745-64 45 1.24 785 21.68 17.4465-74 1 0.68 16 10.91 16.0075-84 1 5.38 4 21.51 4.0085+ 1 25.64 27 692.31 27.00

Unknown 0 0 NATotal 56 0.07 962 1.16 17.18

Inpatient Utilization--Nonacute Care: Total (NONA)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Age Member Months

<1 NR1-9 NR

10-19 NR20-44 NR45-64 NR65-74 NR75-84 NR85+ NR

Unknown NRTotal NR

Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Member Months

Average Length of

Stay




Inpatient Utilization--Nonacute Care: Dual Eligibles (NONB)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Age Member Months

<1 NR1-9 NR

10-19 NR20-44 NR45-64 NR65-74 NR75-84 NR85+ NR

Unknown NRTotal NR

Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Member Months

Average Length of

Stay




Inpatient Utilization--Nonacute Care: Disabled (NONC)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Age Member Months

<1 NR1-9 NR

10-19 NR20-44 NR45-64 NR65-74 NR75-84 NR85+ NR

Unknown NRTotal NR

Age Discharges

Discharges / 1,000

Member Months

DaysDays / 1,000

Member Months

Average Length of

Stay




Inpatient Utilization--Nonacute Care: Other (NOND)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Male Female Total Male Female0-12 NR NR NR NR NR

13-17 NR NR NR NR NR18-24 NR NR NR NR NR25-34 NR NR NR NR NR35-64 NR NR NR NR NR65+ NR NR NR NR NR

Unknown NR NR NR NR NR

Total NR NR NR NR NR

Number Percent Number PercentM NR NR NR NRF NR NR NR NR

Total NR NR NR NRM NR NR NR NRF NR NR NR NR







Total NR NR NR NR

Identification of Alcohol and Other Drug Services: Total (IADA)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Age Member Months (Any) Member Months (Inp

Unknown

Total

0-12

13-17

18-24

25-34

35-64

65+

Age Sex Any Services Inpatient

Total Male Female Total Male Female TotalNR NR NR NR NR NR NRNR NR NR NR NR NR NRNR NR NR NR NR NR NRNR NR NR NR NR NR NRNR NR NR NR NR NR NRNR NR NR NR NR NR NRNR NR NR NR NR NR NR

NR NR NR NR NR NR NR

Number Percent Number PercentNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NR

patient) Member Months (Intensive Outpatient/Partial Hospitalization) Member Months (Outpatient/ED)

Outpatient/EDIntensive

Outpatient/Partial Hospitalization



Unknown NR NR NR NR NRTotal NR NR NR NR NR









Total NR NR NR NR

Identification of Alcohol and Other Drug Services: Dual Eligibles (IADB)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)


Unknown

Total

0-12

13-17

18-24

25-34

35-64

65+


Total Male Female Total Male Female TotalNR NR NR NR NR NR NRNR NR NR NR NR NR NRNR NR NR NR NR NR NRNR NR NR NR NR NR NRNR NR NR NR NR NR NRNR NR NR NR NR NR NRNR NR NR NR NR NR NRNR NR NR NR NR NR NR
















Total NR NR NR NR

Identification of Alcohol and Other Drug Services: Disabled (IADC)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)


Unknown

Total

0-12

13-17

18-24

25-34

35-64

65+













Total NR NR NR NR

Identification of Alcohol and Other Drug Services: Other (IADD)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)


Unknown

Total

0-12

13-17

18-24

25-34

35-64

65+











Total NR NR NR NR

Mental Health Utilization: Total (MPTA)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)


Unknown

Total

0-12

13-17

18-64

65+


Total Male Female Total Male Female TotalNR NR NR NR NR NR NRNR NR NR NR NR NR NRNR NR NR NR NR NR NRNR NR NR NR NR NR NRNR NR NR NR NR NR NRNR NR NR NR NR NR NR

Number Percent Number PercentNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NR













Total NR NR NR NR

Mental Health Utilization: Dual Eligibles (MPTB)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)


Unknown

Total

0-12

13-17

18-64

65+











Total NR NR NR NR

Mental Health Utilization: Disabled (MPTC)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)


Unknown

Total

0-12

13-17

18-64

65+











Total NR NR NR NR

Mental Health Utilization: Other (MPTD)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)


Unknown

Total

0-12

13-17

18-64

65+


Age Male Female Total0-9 214647 201730 416,377

10-17 115447 113571 229,01818-34 28297 89596 117,89335-49 13306 26057 39,36350-64 11520 13965 25,48565-74 525 941 1,46675-84 90 96 18685+ 12 27 39

Unknown 0 0 0Total 383,844 445,983 829,827

Age SexTotal

Antibiotic Scrips

Average Scrips

PMPY for Antibiotics

Total Days Supplied for

All Antibiotic

Scrips

Average Days

Supplied per

Antibiotic Scrip

M 21202 1.19 185741 8.76F 19831 1.18 179529 9.05

Total 41,033 1.18 365,270 8.90M 6981 0.73 68086 9.75F 9012 0.95 81880 9.09

Total 15,993 0.84 149,966 9.38M 2092 0.89 21397 10.23F 11938 1.60 99058 8.30

Total 14,030 1.43 120,455 8.59M 1187 1.07 11751 9.90F 3849 1.77 33906 8.81

Total 5,036 1.54 45,657 9.07M 1063 1.11 12181 11.46F 2216 1.90 20679 9.33

Total 3,279 1.54 32,860 10.02M 52 1.19 693 13.33F 104 1.33 862 8.29

Total 156 1.28 1,555 9.97M 10 1.33 159 15.90F 11 1.38 88 8.00

Total 21 1.35 247 11.76M 6 6.00 36 6.00F 1 0.44 30 30.00

Total 7 2.15 66 9.43M 0 NA 0 NAF 0 NA 0 NA

Total 0 NA 0 NAM 32,593 1.02 300,044 9.21F 46,962 1.26 416,032 8.86

Total 79,555 1.15 716,076 9.00

Antibiotic Utilization: Total (ABXA)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Pharmacy Benefit Member Months

Antibiotic Utilization

0-9

10-17

18-34

35-49

50-64

65-74

75-84

85+

Unknown

Total

Antib

Age SexTotal

Quinolone Scrips

Average Scrips

PMPY for Quinolones

Total Cephalo-

sporin 2nd-4th

Generation Scrips

Average Scrips

PMPY for Cephalo-

sporins 2nd-4th

GenerationM 7 0.00 1439 0.08F 13 0.00 1367 0.08

Total 20 0.00 2,806 0.08M 48 0.00 229 0.02F 170 0.02 376 0.04

Total 218 0.01 605 0.03M 152 0.06 37 0.02F 1027 0.14 227 0.03

Total 1,179 0.12 264 0.03M 111 0.10 32 0.03F 504 0.23 71 0.03

Total 615 0.19 103 0.03M 190 0.20 20 0.02F 412 0.35 43 0.04

Total 602 0.28 63 0.03M 11 0.25 1 0.02F 22 0.28 0 0.00

Total 33 0.27 1 0.01M 2 0.27 1 0.13F 5 0.63 0 0.00

Total 7 0.45 1 0.06M 3 3.00 0 0.00F 0 0.00 0 0.00


Total 0 NA 0 NAM 524 0.02 1,759 0.05F 2,153 0.06 2,084 0.06

Total 2,677 0.04 3,843 0.06

Age Sex

Total Absorbable Sulfonamide

Scrips

Average Scrips

PMPY for Absorbable Sulfonamide

s

Total Amino- glycoside

Scrips

Average Scrips

PMPY for Amino-

glycosides

M 879 0.05 2 0.00F 1302 0.08 4 0.00

Total 2,181 0.06 6 0.00M 311 0.03 7 0.00F 637 0.07 1 0.00

Total 948 0.05 8 0.00M 154 0.07 0 0.00F 891 0.12 1 0.00

Total 1,045 0.11 1 0.00M 159 0.14 0 0.00F 354 0.16 0 0.00

Total 513 0.16 0 0.00

0-9

10-17

18-34

35-49

50-64

65-74

75-84

85+

Unknown

Total

0-9

10-17

18-34

35-49

M 117 0.12 0 0.00F 194 0.17 0 0.00

Total 311 0.15 0 0.00M 2 0.05 0 0.00F 15 0.19 0 0.00

Total 17 0.14 0 0.00M 1 0.13 0 0.00F 0 0.00 0 0.00

Total 1 0.06 0 0.00M 0 0.00 0 0.00F 0 0.00 0 0.00


Total 0 NA 0 NAM 1,623 0.05 9 0.00F 3,393 0.09 6 0.00

Total 5,016 0.07 15 0.00Total

50-64

65-74

75-84

85+

Unknown

Total Number of Scrips for Antibiotics of Concern

Average Scrips

PMPY for Anitbiotics of Concern

Percentage of

Antibiotics of Concern

of all Antibiotic

S i10220 0.57 48.20%8829 0.53 44.52%

19,049 0.55 46.42%3363 0.35 48.17%4166 0.44 46.23%7,529 0.39 47.08%927 0.39 44.31%

4968 0.67 41.62%5,895 0.60 42.02%502 0.45 42.29%

1826 0.84 47.44%2,328 0.71 46.23%485 0.51 45.63%

1099 0.94 49.59%1,584 0.75 48.31%

21 0.48 40.38%60 0.77 57.69%81 0.66 51.92%3 0.40 30.00%8 1.00 72.73%

11 0.71 52.38%3 3.00 50.00%0 0.00 0.00%3 0.92 42.86%0 NA NA0 NA NA0 NA NA

15,524 0.49 47.63%20,956 0.56 44.62%36,480 0.53 45.86%

biotics of Concern Utilization

Total Azithromyci

n and Clarithro-

mycin Scrips

Average Scrips

PMPY for Azithromyci

ns and Clarithro- mycins

Total Amoxicillin/ Clavulanate

Scrips

Average Scrips

PMPY for Amoxicillin/ Clavulanate

s

Total Ketolides

Scrips

Average Scrips

PMPY for Ketolides

Total Clindamycin

Scrips

Average Scrips

PMPY for Clindamycin

s

5304 0.30 3334 0.19 0 0.00 125 0.014616 0.27 2705 0.16 0 0.00 128 0.019,920 0.29 6,039 0.17 0 0.00 253 0.012053 0.21 925 0.10 0 0.00 107 0.012520 0.27 967 0.10 0 0.00 133 0.014,573 0.24 1,892 0.10 0 0.00 240 0.01453 0.19 190 0.08 0 0.00 95 0.04

2474 0.33 824 0.11 0 0.00 413 0.062,927 0.30 1,014 0.10 0 0.00 508 0.05194 0.17 107 0.10 0 0.00 53 0.05794 0.37 295 0.14 0 0.00 162 0.07988 0.30 402 0.12 0 0.00 215 0.07136 0.14 82 0.09 0 0.00 37 0.04429 0.37 128 0.11 0 0.00 79 0.07565 0.27 210 0.10 0 0.00 116 0.05

5 0.11 4 0.09 0 0.00 0 0.0031 0.40 7 0.09 0 0.00 0 0.0036 0.29 11 0.09 0 0.00 0 0.000 0.00 0 0.00 0 0.00 0 0.003 0.38 0 0.00 0 0.00 0 0.003 0.19 0 0.00 0 0.00 0 0.000 0.00 0 0.00 0 0.00 0 0.000 0.00 0 0.00 0 0.00 0 0.000 0.00 0 0.00 0 0.00 0 0.000 NA 0 NA 0 NA 0 NA0 NA 0 NA 0 NA 0 NA0 NA 0 NA 0 NA 0 NA

8,145 0.25 4,642 0.15 0 0.00 417 0.0110,867 0.29 4,926 0.13 0 0.00 915 0.0219,012 0.27 9,568 0.14 0 0.00 1,332 0.02

Total 1st Generation Cephalo-

sporin Scrips

Average Scrips

PMPY for 1st

Generation Cephalo-

i

Total Lincosamid

e Scrips

Average Scrips

PMPY for Lincosamid

es

Total Macrolides

(not azith. or clarith.) Scrips

Average Scrips

PMPY for Macrolides

(not azith. or clarith.)

Total Penicillin

Scrips

Average Scrips

PMPY for Penicillins

1309 0.07 0 0.00 55 0.00 8657 0.481590 0.09 0 0.00 88 0.01 7777 0.462,899 0.08 0 0.00 143 0.00 16,434 0.47666 0.07 0 0.00 53 0.01 2023 0.21894 0.09 0 0.00 82 0.01 2310 0.24

1,560 0.08 0 0.00 135 0.01 4,333 0.23223 0.09 0 0.00 25 0.01 465 0.20

1137 0.15 0 0.00 107 0.01 2206 0.301,360 0.14 0 0.00 132 0.01 2,671 0.27141 0.13 0 0.00 14 0.01 257 0.23335 0.15 0 0.00 24 0.01 671 0.31476 0.15 0 0.00 38 0.01 928 0.28

All Other Antibiotics Utilization

145 0.15 0 0.00 11 0.01 184 0.19246 0.21 0 0.00 16 0.01 305 0.26391 0.18 0 0.00 27 0.01 489 0.23

6 0.14 0 0.00 0 0.00 4 0.0913 0.17 0 0.00 0 0.00 7 0.0919 0.16 0 0.00 0 0.00 11 0.093 0.40 0 0.00 0 0.00 2 0.270 0.00 0 0.00 0 0.00 3 0.383 0.19 0 0.00 0 0.00 5 0.320 0.00 0 0.00 0 0.00 0 0.000 0.00 0 0.00 0 0.00 0 0.000 0.00 0 0.00 0 0.00 0 0.000 NA 0 NA 0 NA 0 NA0 NA 0 NA 0 NA 0 NA0 NA 0 NA 0 NA 0 NA

2,493 0.08 0 0.00 158 0.00 11,592 0.364,215 0.11 0 0.00 317 0.01 13,279 0.366,708 0.10 0 0.00 475 0.01 24,871 0.36

Total Misc. Antibiotics of Concern

Scrips

Average Scrips

PMPY for Misc.


11 0.000 0.00

11 0.001 0.000 0.001 0.000 0.003 0.003 0.005 0.000 0.005 0.00

20 0.028 0.01

28 0.010 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 NA0 NA0 NA

37 0.0011 0.0048 0.00

Total Tetracycline

Scrips

Average Scrips

PMPY for Tetracycline

s

Total Misc. Antibiotic

Scrips

Average Scrips

PMPY for Misc.

Antibiotics

10 0.00 70 0.002 0.00 239 0.01

12 0.00 309 0.01522 0.05 36 0.00477 0.05 445 0.05999 0.05 481 0.03249 0.11 49 0.02767 0.10 1861 0.25

1,016 0.10 1,910 0.1983 0.07 31 0.03

261 0.12 378 0.17344 0.10 409 0.12

96 0.10 25 0.03171 0.15 185 0.16267 0.13 210 0.1018 0.41 1 0.026 0.08 3 0.04

24 0.20 4 0.031 0.13 0 0.000 0.00 0 0.001 0.06 0 0.001 1.00 2 2.000 0.00 1 0.441 0.31 3 0.920 NA 0 NA0 NA 0 NA0 NA 0 NA

980 0.03 214 0.011,684 0.05 3,112 0.082,664 0.04 3,326 0.05

Male Female Total0-9 NR NR NR

10-17 NR NR NR18-34 NR NR NR35-49 NR NR NR50-64 NR NR NR65-74 NR NR NR75-84 NR NR NR85+ NR NR NR

Unknown NR NR NRTotal NR NR NR

Age SexTotal

Antibiotic Scrips

Average Scrips



All Antibiotic

Scrips

Average Days

Supplied per

Antibiotic Scrip

M NR NR NR NRF NR NR NR NR










Total NR NR NR NR

Antibiotic Utilization: Dual Eligibles (ABXB)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Member Months

Age Member Months


0-9

10-17

18-34

35-49

50-64

65-74

75-84

85+

Unknown

Total

Antib

Age SexTotal

Quinolone Scrips

Average Scrips

PMPY for Quinolones

Total Cephalosporin 2nd-4th Generation

Scrips

Average Scrips

PMPY for Cephalosporins 2nd-4th Generation











Total NR NR NR NR

Age Sex


Scrips

Average Scrips


s

Total Aminoglycoside Scrips

Average Scrips

PMPY for Aminoglyco

sides





Total NR NR NR NR

0-9

10-17

18-34

35-49

50-64

65-74

75-84

85+

Unknown

Total

0-9

10-17

18-34

35-49







Total NR NR NR NR

Unknown

Total

50-64

65-74

75-84

85+


Average Scrips


Percentage of


of all Antibiotic

S iNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NRNR NR NR


Total Azithromyci

n and Clarithromycin Scrips

Average Scrips


ns and Clarithromy

cins


Scrips

Average Scrips


s

Total Ketolides

Scrips

Average Scrips

PMPY for Ketolides

Total Clindamycin

Scrips

Average Scrips


s

NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR

Total 1st Generation Cephalospo

rin Scrips

Average Scrips

PMPY for 1st

Generation Cephalospo

i

Total Lincosamid

e Scrips

Average Scrips

PMPY for Lincosamid

es

Total Macrolides


Average Scrips

PMPY for Macrolides


Total Penicillin

Scrips

Average Scrips


NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR


NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR


Scrips

Average Scrips

PMPY for Misc.


NR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NRNR NR

Total Tetracycline

Scrips

Average Scrips


s


Scrips

Average Scrips

PMPY for Misc.

Antibiotics

NR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NR

NR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NRNR NR NR NR




Age SexTotal

Antibiotic Scrips

Average Scrips



All Antibiotic

Scrips

Average Days

Supplied per

Antibiotic Scrip











Total NR NR NR NR

Antibiotic Utilization: Disabled (ABXC)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Member Months

Age Member Months


0-9

10-17

18-34

35-49

50-64

65-74

75-84

85+

Unknown

Total

Antib

Age SexTotal

Quinolone Scrips

Average Scrips

PMPY for Quinolones


Scrips

Average Scrips












Total NR NR NR NR

Age Sex


Scrips

Average Scrips


s


Average Scrips

PMPY for Aminoglyco

sides





Total NR NR NR NR

0-9

10-17

18-34

35-49

50-64

65-74

75-84

85+

Unknown

Total

0-9

10-17

18-34

35-49







Total NR NR NR NR

Unknown

Total

50-64

65-74

75-84

85+


Average Scrips


Percentage of


of all Antibiotic



Total Azithromyci


Average Scrips


ns and Clarithromy

cins


Scrips

Average Scrips


s

Total Ketolides

Scrips

Average Scrips

PMPY for Ketolides

Total Clindamycin

Scrips

Average Scrips


s



rin Scrips

Average Scrips

PMPY for 1st


i

Total Lincosamid

e Scrips

Average Scrips

PMPY for Lincosamid

es

Total Macrolides


Average Scrips

PMPY for Macrolides


Total Penicillin

Scrips

Average Scrips





Scrips

Average Scrips

PMPY for Misc.



Total Tetracycline

Scrips

Average Scrips


s


Scrips

Average Scrips

PMPY for Misc.

Antibiotics





Age SexTotal

Antibiotic Scrips

Average Scrips



All Antibiotic

Scrips

Average Days

Supplied per

Antibiotic Scrip











Total NR NR NR NR

Antibiotic Utilization: Other (ABXD)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Member Months

Age Member Months


0-9

10-17

18-34

35-49

50-64

65-74

75-84

85+

Unknown

Total

Antib

Age SexTotal

Quinolone Scrips

Average Scrips

PMPY for Quinolones


Scrips

Average Scrips












Total NR NR NR NR

Age Sex


Scrips

Average Scrips


s


Average Scrips

PMPY for Aminoglyco

sides





Total NR NR NR NR

0-9

10-17

18-34

35-49

50-64

65-74

75-84

85+

Unknown

Total

0-9

10-17

18-34

35-49







Total NR NR NR NR

Unknown

Total

50-64

65-74

75-84

85+


Average Scrips


Percentage of


of all Antibiotic



Total Azithromyci


Average Scrips


ns and Clarithromy

cins


Scrips

Average Scrips


s

Total Ketolides

Scrips

Average Scrips

PMPY for Ketolides

Total Clindamycin

Scrips

Average Scrips


s



rin Scrips

Average Scrips

PMPY for 1st


i

Total Lincosamid

e Scrips

Average Scrips

PMPY for Lincosamid

es

Total Macrolides


Average Scrips

PMPY for Macrolides


Total Penicillin

Scrips

Average Scrips





Scrips

Average Scrips

PMPY for Misc.



Total Tetracycline

Scrips

Average Scrips


s


Scrips

Average Scrips

PMPY for Misc.

Antibiotics


Age Member Months

0-9 41637710-17 22901818-34 11789335-49 3936350-64 2548565-74 146675-84 18685+ 39


Age

Total Cost of

Prescriptions

Avg. Cost of Prescription

s/ Per Member Per

Month

Total Number of

Prescriptions

Avg. Num. of

Prescriptions/ Per

Member Per Y0-9 5561450 $13.36 158703 4.57

10-17 4467351 $19.51 88405 4.6318-34 4787476 $40.61 105700 10.7635-49 3953489 $100.44 83763 25.5450-64 4961634 $194.69 101042 47.5865-74 259243 $176.84 7279 59.5875-84 13805 $74.22 460 29.6885+ 2480 $63.59 85 26.15

Unknown 0 0

Total $24,006,928.00 $28.93 545,437 7.89

Outpatient Drug Utilization: Total (ORXA)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)


Age Member Months

0-9 NR10-17 NR18-34 NR35-49 NR50-64 NR65-74 NR75-84 NR85+ NR

Unknown NRTotal NR

Age

Total Cost of

Prescriptions


s/ Per Member Per

Month

Total Number of

Prescriptions

Avg. Num. of

Prescriptions/ Per

Member Per Y0-9 NR NR NR NR

10-17 NR NR NR NR18-34 NR NR NR NR35-49 NR NR NR NR50-64 NR NR NR NR65-74 NR NR NR NR75-84 NR NR NR NR85+ NR NR NR NR

Unknown NR NRTotal NR NR NR NR

Outpatient Drug Utilization: Dual Eligibles (ORXB)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)


Age Member Months


Unknown NRTotal NR

Age

Total Cost of

Prescriptions


s/ Per Member Per

Month

Total Number of

Prescriptions

Avg. Num. of

Prescriptions/ Per




Outpatient Drug Utilization: Disabled (ORXC)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)


Age Member Months


Unknown NRTotal NR

Age

Total Cost of

Prescriptions


s/ Per Member Per

Month

Total Number of

Prescriptions

Avg. Num. of

Prescriptions/ Per




Outpatient Drug Utilization: Other (ORXD)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)


Category Eligible Population

Total 939Exclusions (required) 26

Type 1 with Comorbidity 102Type 2 with Comorbidity 563

Type 1 without Comorbidity 30Type 2 without Comorbidity 244

Male Female Total Male Female18-44* 143 252 395 96 19045-54 120 215 335 24 2455-64 156 240 396 0 2465-75 0 96 96 0 0Total 419 803 1,222 120 238

Male Female Total Male Female18-44 143 252 395 96 19045-54 120 215 335 24 2455-64 156 240 396 0 2465-75 0 96 96 0 0Total 419 803 1,222 120 238

Inpatient Facility

E & M - Inpatient

E & M - Outpatient

Surgery and Procedure -

InpatientM 136547 5619 12144 1877F 186032 7258 20743 6490

Total $322,579.00 $12,877.00 $32,887.00 $8,367.00M 44723 2196 14919 0F 46034 3793 23237 430

Total $90,757.00 $5,989.00 $38,156.00 $430.00M 72309 2983 11991 4911F 187660 7919 26596 1860

Total $259,969.00 $10,902.00 $38,587.00 $6,771.00M 0 0 0 0F 29440 2113 10291 0

Total $29,440.00 $2,113.00 $10,291.00 $0.00M $253,579.00 $10,798.00 $39,054.00 $6,788.00F $449,166.00 $21,083.00 $80,867.00 $8,780.00

Total $702,745.00 $31,881.00 $119,921.00 $15,568.00

Relative Resource Use for People With Diabetes (RDI)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Eligible Population

Medical Benefit Membe

AgeMember Months (Diabetes Type 1 with

Comorbidity)Member Months (Diabet

without Comorbid

* Include any Member Months that occur at age 17 in the 18-44 category.Pharmacy Benefit Memb

AgeMember Months (Diabetes Type 1 with

Comorbidity)Member Months (Diabet

without Comorbid

Diabetes Type 1 with Comorbidity

Age Sex

Total Standard Cost by Service Category, A

18-44

45-54

55-64

65-75

Total

Diabetes Type 1 without Comorbidity

Inpatient Facility

E & M - Inpatient

E & M - Outpatient


InpatientM 47472 3539 6270 1199F 22292 1340 14354 0

Total $69,764.00 $4,879.00 $20,624.00 $1,199.00M 0 146 980 0F 0 0 2562 0

Total $0.00 $146.00 $3,542.00 $0.00M 0 0 0 0F 0 0 2067 0

Total $0.00 $0.00 $2,067.00 $0.00M 0 0 0 0F 0 0 0 0

Total $0.00 $0.00 $0.00 $0.00M $47,472.00 $3,685.00 $7,250.00 $1,199.00F $22,292.00 $1,340.00 $18,983.00 $0.00

Total $69,764.00 $5,025.00 $26,233.00 $1,199.00

Inpatient Facility

E & M - Inpatient

E & M - Outpatient


InpatientM 110985 4243 28668 1191F 237926 10718 114393 21771

Total $348,911.00 $14,961.00 $143,061.00 $22,962.00M 181473 10820 47216 8443F 551456 27223 103297 48715

Total $732,929.00 $38,043.00 $150,513.00 $57,158.00M 276312 9318 68700 11649F 626469 28890 137847 31377

Total $902,781.00 $38,208.00 $206,547.00 $43,026.00M 61027 2654 9728 2642F 83771 5715 23556 2117

Total $144,798.00 $8,369.00 $33,284.00 $4,759.00M $629,797.00 $27,035.00 $154,312.00 $23,925.00

F $1,499,622.00 $72,546.00 $379,093.00 $103,980.00

Total $2,129,419.00 $99,581.00 $533,405.00 $127,905.00

Inpatient Facility

E & M - Inpatient

E & M - Outpatient


InpatientM 120522 4522 16001 6044F 157616 4324 64894 8271

Total $278,138.00 $8,846.00 $80,895.00 $14,315.00M 46841 2114 9884 3182

Age Sex


18-44

45-54

55-64

65-75

Total

Diabetes Type 2 with Comorbidity

Age Sex


18-44

45-54

55-64

65-75

Total

Diabetes Type 2 without Comorbidity

Age Sex


18-44

F 79908 2993 28121 4162Total $126,749.00 $5,107.00 $38,005.00 $7,344.00

M 0 0 7697 0F 11105 476 23704 133

Total $11,105.00 $476.00 $31,401.00 $133.00M 0 0 593 0F 0 0 1787 0

Total $0.00 $0.00 $2,380.00 $0.00M $167,363.00 $6,636.00 $34,175.00 $9,226.00F $248,629.00 $7,793.00 $118,506.00 $12,566.00

Total $415,992.00 $14,429.00 $152,681.00 $21,792.00

Inpatient Facility - PMPM

E & M - Inpatient -

PMPM

E & M - Outpatient -

PMPM

Surgery and Procedure - Inpatient -

PMPM

M $418.88 $18.07 $63.59 $10.39F $200.49 $7.85 $71.18 $12.13

Total $254.59 $10.38 $69.30 $11.70M $227.91 $12.75 $60.93 $9.70F $382.28 $19.19 $88.72 $30.08

Total $320.01 $16.59 $77.51 $21.86M $274.94 $9.70 $69.71 $13.06F $353.87 $15.99 $81.57 $14.31

Total $326.07 $13.77 $77.39 $13.87M $339.04 $14.74 $57.34 $14.68F $235.86 $16.31 $74.24 $4.41

Total $264.00 $15.88 $69.63 $7.21M $301.87 $13.24 $64.54 $11.31F $292.22 $13.53 $78.65 $16.50

Total $295.35 $13.43 $74.08 $14.82

18-44

45-54

45-54

55-64

65-75

Total

Diabetes Totals


55-64

65-75

Total

Age Sex

Total Male Female Total Male Female Total286 384 1341 1,725 369 1229 1,59848 791 1077 1,868 263 456 71924 932 1699 2,631 180 369 5490 168 348 516 12 36 48

358 2,275 4,465 6,740 824 2,090 2,914

Total Male Female Total Male Female Total286 384 1341 1,725 369 1229 1,59848 791 1077 1,868 263 456 71924 932 1699 2,631 180 369 5490 168 348 516 12 36 48

358 2,275 4,465 6,740 824 2,090 2,914

Surgery and Procedure - Outpatient

PharmacyInpatient Facility

DischargesED Visits

5890 46617 18 1810548 66815 28 59

$16,438.00 $113,432.00 46 7711692 71253 6 2524612 97125 7 29

$36,304.00 $168,378.00 13 549321 68446 7 12

11198 99869 15 32$20,519.00 $168,315.00 22 44

0 0 0 04168 26172 4 5

$4,168.00 $26,172.00 4 5$26,903.00 $186,316.00 31 55$50,526.00 $289,981.00 54 125$77,429.00 $476,297.00 85 180

er Months tes Type 1

dity)Member Months (Diabetes Type 2 with

Comorbidity)Member Months (Diabetes Type 2

without Comorbidity)

ber Months tes Type 1

dity)Member Months (Diabetes Type 2 with

Comorbidity)Member Months (Diabetes Type 2

without Comorbidity)

Age, and GenderTotal Service Frequency

by Service Category, Age, and Gender



DischargesED Visits

1748 20026 10 154744 48310 5 52

$6,492.00 $68,336.00 15 6787 3379 0 2

1227 8576 0 4$1,314.00 $11,955.00 0 6

0 0 0 0354 1782 0 1

$354.00 $1,782.00 0 10 0 0 00 0 0 0

$0.00 $0.00 0 0$1,835.00 $23,405.00 10 17$6,325.00 $58,668.00 5 57$8,160.00 $82,073.00 15 74



DischargesED Visits

8176 82291 8 8335971 217076 30 328

$44,147.00 $299,367.00 38 41119169 198379 16 7057303 332101 54 207

$76,472.00 $530,480.00 70 27733651 270440 20 5986296 462964 52 166

$119,947.00 $733,404.00 72 2253589 39405 3 13

17529 86236 6 31$21,118.00 $125,641.00 9 44$64,585.00 $590,515.00 47 225

$197,099.00 $1,098,377.00 142 732

$261,684.00 $1,688,892.00 189 957



DischargesED Visits

5727 40696 10 3318566 84930 25 124

$24,293.00 $125,626.00 35 1574863 56752 5 17







18482 85084 10 46$23,345.00 $141,836.00 15 63

6585 41499 0 512426 62164 3 38

$19,011.00 $103,663.00 3 43225 3252 0 082 3051 0 0

$307.00 $6,303.00 0 0$17,400.00 $142,199.00 15 55$49,556.00 $235,229.00 38 208$66,956.00 $377,428.00 53 263

Surgery and Procedure - Outpatient -

PMPM

Pharmacy - PMPM

Inpatient Facility

Discharges/ 1,000

Member Years

ED Visits/1,000

Member Years

$21.71 $191.16 556.45 1,802.42$23.18 $138.49 350.60 2,243.03$22.82 $151.54 401.60 2,133.87$29.89 $275.26 270.45 1,141.90$57.35 $295.08 480.81 1,936.79$46.27 $287.09 395.96 1,616.16$39.08 $299.99 255.52 719.24$47.29 $268.77 360.21 1,219.55$44.40 $279.77 323.33 1,043.33$21.19 $236.98 200.00 866.67$45.37 $240.54 250.00 900.00$38.78 $239.57 236.36 890.91$30.44 $259.05 339.75 1,161.08$39.96 $221.47 377.57 1,772.51$36.87 $233.64 365.32 1,574.51

Total Service Frequency by Service Category, Age,

and Gender

Age, and Gender



With Comorbidity 75Without Comorbidity 726

Male Female Total Male Female5-17* 168 132 300 4595 296318-44 120 371 491 359 68245-50 24 84 108 24 83Total 312 587 899 4,978 3,728

Inpatient Facility

E & M - Inpatient

E & M - Outpatient


InpatientM 0 0 13559 425F 14404 1146 9950 0

Total $14,404.00 $1,146.00 $23,509.00 $425.00M 0 278 7943 0F 47669 2867 30328 1832

Total $47,669.00 $3,145.00 $38,271.00 $1,832.00M 0 0 1224 0F 0 0 6494 0

Total $0.00 $0.00 $7,718.00 $0.00M $0.00 $278.00 $22,726.00 $425.00F $62,073.00 $4,013.00 $46,772.00 $1,832.00

Total $62,073.00 $4,291.00 $69,498.00 $2,257.00

Inpatient Facility

E & M - Inpatient

E & M - Outpatient


InpatientM 312126 18027 209352 2407F 97599 7595 130091 141

Total $409,725.00 $25,622.00 $339,443.00 $2,548.00M 7344 0 12194 0F 47480 1018 30847 0

Total $54,824.00 $1,018.00 $43,041.00 $0.00M 0 0 1304 0F 0 0 5102 0

Total $0.00 $0.00 $6,406.00 $0.00M $319,470.00 $18,027.00 $222,850.00 $2,407.00

Relative Resource Use for People With Asthma (RAS)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Eligible Population

Medical and Pharmacy Benefit

Age

Medical Benefit Member MonthsMember Months (Asthma with

Comorbidity)Member Months (Asthm

Comorbidity)

Age Sex


* Include any Member Months that occur at age 4 in the 5-17 age category.Asthma with Comorbidity

Age Sex


5-17

18-44

45-50

Total

Asthma without Comorbidity

5-17

18-44

45-50

F $145,079.00 $8,613.00 $166,040.00 $141.00Total $464,549.00 $26,640.00 $388,890.00 $2,548.00


E & M - Inpatient -

PMPM


PMPM


PMPM

M $65.53 $3.78 $46.80 $0.59F $36.19 $2.82 $45.25 $0.05

Total $53.97 $3.41 $46.19 $0.38M $15.33 $0.58 $42.04 $0.00F $90.36 $3.69 $58.10 $1.74

Total $66.90 $2.72 $53.08 $1.20M $0.00 $0.00 $52.67 $0.00F $0.00 $0.00 $69.44 $0.00

Total $0.00 $0.00 $65.69 $0.00M $60.39 $3.46 $46.42 $0.54F $48.01 $2.93 $49.32 $0.46

Total $54.83 $3.22 $47.72 $0.50

5-17

18-44

45-50

Total

Total

Asthma Totals

Age Sex

Total standard Cost by Service Category, A

Total Male Female Total Male Female Total7,558 168 132 300 4595 2963 7,5581,041 120 371 491 359 682 1,041107 24 84 108 24 83 107

8,706 312 587 899 4,978 3,728 8,706



DischargesED Visits

1047 22669 0 152231 24107 3 14

$3,278.00 $46,776.00 3 29531 24283 0 15

8798 110828 8 82$9,329.00 $135,111.00 8 97

9 7003 0 21423 18981 0 6

$1,432.00 $25,984.00 0 8$1,587.00 $53,955.00 0 32

$12,452.00 $153,916.00 11 102$14,039.00 $207,871.00 11 134



DischargesED Visits

24483 446658 49 33313590 247345 19 209

$38,073.00 $694,003.00 68 54213078 54665 1 2520148 95059 10 106

$33,226.00 $149,724.00 11 1310 15533 0 0

5128 43864 0 3$5,128.00 $59,397.00 0 3

$37,561.00 $516,856.00 50 358

t Member Months Pharmacy Benefit Member Months

ma without Member Months (Asthma with Comorbidity)



Member Months (Asthma without Comorbidity)



$38,866.00 $386,268.00 29 318$76,427.00 $903,124.00 79 676


PMPM

Pharmacy - PMPM

Inpatient Facility

Discharges/ 1,000

Member Years

ED Visits/1,000

Member Years

$5.36 $98.54 123.45 876.76$5.11 $87.71 85.30 864.62$5.26 $94.27 108.42 871.98

$28.41 $164.82 25.05 1,002.09$27.49 $195.52 205.13 2,142.45$27.78 $185.92 148.83 1,785.90$0.19 $469.50 0.00 500.00$39.23 $376.32 0.00 646.71$30.51 $397.12 0.00 613.95$7.40 $107.90 113.42 884.69

$11.89 $125.19 111.24 1,168.02$9.42 $115.67 112.44 1,011.97





Male Female Total Male Female18-44* 118 500 618 118 50045-50 26 52 78 26 52Total 144 552 696 144 552

Inpatient Facility

E & M - Inpatient

E & M - Outpatient


InpatientM 0 0 6826 0F 8464 0 24295 0

Total $8,464.00 $0.00 $31,121.00 $0.00M 0 0 1127 0F 0 0 3005 0

Total $0.00 $0.00 $4,132.00 $0.00M $0.00 $0.00 $7,953.00 $0.00F $8,464.00 $0.00 $27,300.00 $0.00

Total $8,464.00 $0.00 $35,253.00 $0.00


E & M - Inpatient -

PMPM


PMPM


PMPM

M $0.00 $0.00 $57.85 $0.00F $16.93 $0.00 $48.59 $0.00

Total $13.70 $0.00 $50.36 $0.00M $0.00 $0.00 $43.35 $0.00F $0.00 $0.00 $57.79 $0.00

Total $0.00 $0.00 $52.97 $0.00M $0.00 $0.00 $55.23 $0.00F $15.33 $0.00 $49.46 $0.00

Total $12.16 $0.00 $50.65 $0.00

Relative Resource Use for People With Acute Lower Back Pain (RLB)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Eligible Population

Medical and Pharmacy Benefit Member Months

AgeMedical Benefit Member Months (Acute

Low Back Pain)Pharmacy Benefit Memb

(Acute Low Back P

* Include any Member Months that occur at age 17 in the 18-44 age category.

Age Sex


18-44

18-44

45-50

Total

45-50

Total

Low Back Pain Totals

Age Sex


Total61878

696



DischargesED Visits MRIs

45 2778 0 12 4610 10102 1 71 16

$655.00 $12,880.00 1 83 200 1544 0 2 1

27 4286 0 3 1$27.00 $5,830.00 0 5 2$45.00 $4,322.00 0 14 5

$637.00 $14,388.00 1 74 17$682.00 $18,710.00 1 88 22


PMPM

Pharmacy - PMPM

Inpatient Facility

Discharges/ 1,000

Member Years

ED Visits/1,000

Member Years

MRIs/1,000 Member

Years

$0.38 $23.54 0.00 1,220.34 406.78$1.22 $20.20 24.00 1,704.00 384.00$1.06 $20.84 19.42 1,611.65 388.35$0.00 $59.38 0.00 923.08 461.54$0.52 $82.42 0.00 692.31 230.77$0.35 $74.74 0.00 769.23 307.69$0.31 $30.01 0.00 1,166.67 416.67$1.15 $26.07 21.74 1,608.70 369.57$0.98 $26.88 17.24 1,517.24 379.31

ber Months

Pain)

Age, and Gender Total Service Frequency by Service Category, Age, and Gender

Age, and Gender Total Service Frequency by Service Category, Age, and Gender

Category Eligible Population Category Eligible

PopulationTotal 129

Exclusions (required) 2

CHF With Comorbidity 26 Angina With Comorbidity 8

CHF Without Comorbidity 3Angina Without

Comorbidity0

AMI With Comorbidity 5 CAD With Comorbidity 80

AMI Without Comorbidity 0CAD

Without 7

Male Female Total Male Female18-44 0 12 12 0 045-54 36 24 60 24 055-64 84 120 204 12 065-75 12 24 36 0 0Total 132 180 312 36 0




Relative Resource Use for People With Cardiovascular Conditions (RCA)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Eligible Population

Medical Benefit Membe

Age Member Months (CHF With

Comorbidity)Member Months (CHF

Comorbidity)

Age Member Months (Angina With

Comorbidity)Member Months (Angin

Comorbidity)

Pharmacy Benefit Memb

Age Member Months (CHF With

Comorbidity)Member Months (CHF

Comorbidity)

Age Member Months (Angina With

Comorbidity)Member Months (Angin

Comorbidity)

CHF with Comorbidity

Age Sex


Inpatient Facility

E & M - Inpatient

E & M - Outpatient


InpatientM 0 0 0 0F 75000 2500 1322 6154

Total $75,000.00 $2,500.00 $1,322.00 $6,154.00M 24029 1161 5959 1626F 0 0 2616 0

Total $24,029.00 $1,161.00 $8,575.00 $1,626.00M 35468 2544 8696 2098F 194904 9389 15322 6551

Total $230,372.00 $11,933.00 $24,018.00 $8,649.00M 0 0 264 0F 9728 636 3245 0

Total $9,728.00 $636.00 $3,509.00 $0.00M $59,497.00 $3,705.00 $14,919.00 $3,724.00F $279,632.00 $12,525.00 $22,505.00 $12,705.00

Total $339,129.00 $16,230.00 $37,424.00 $16,429.00

Inpatient Facility

E & M - Inpatient

E & M - Outpatient


InpatientM 0 0 0 0F 0 0 0 0

Total $0.00 $0.00 $0.00 $0.00M 0 0 849 0F 0 0 0 0

Total $0.00 $0.00 $849.00 $0.00M 0 0 447 0F 0 0 0 0

Total $0.00 $0.00 $447.00 $0.00M 0 0 0 0F 0 0 0 0

Total $0.00 $0.00 $0.00 $0.00M $0.00 $0.00 $1,296.00 $0.00F $0.00 $0.00 $0.00 $0.00

Total $0.00 $0.00 $1,296.00 $0.00

Inpatient Facility

E & M - Inpatient

E & M - Outpatient


InpatientM 39090 764 501 4015F 0 0 0 0

Total $39,090.00 $764.00 $501.00 $4,015.00M 23139 803 962 3434F 0 0 0 0

Total $23,139.00 $803.00 $962.00 $3,434.00M 0 0 718 0F 0 0 918 0

Total $0.00 $0.00 $1,636.00 $0.00

Age Sex

18-44

45-54

55-64

65-75

Total

CHF without Comorbidity

Age Sex


18-44

45-54

55-64

65-75

Total

AMI with Comorbidity

Age Sex


18-44

45-54

55-64

M 52660 2415 360 2642F 0 0 0 0

Total $52,660.00 $2,415.00 $360.00 $2,642.00M $114,889.00 $3,982.00 $2,541.00 $10,091.00F $0.00 $0.00 $918.00 $0.00

Total $114,889.00 $3,982.00 $3,459.00 $10,091.00

Inpatient Facility

E & M - Inpatient

E & M - Outpatient



Total $0.00 $0.00 $0.00 $0.00M 0 0 0 0F 0 0 0 0

Total $0.00 $0.00 $0.00 $0.00M 0 0 0 0F 0 0 0 0

Total $0.00 $0.00 $0.00 $0.00M 0 0 0 0F 0 0 0 0

Total $0.00 $0.00 $0.00 $0.00M $0.00 $0.00 $0.00 $0.00F $0.00 $0.00 $0.00 $0.00

Total $0.00 $0.00 $0.00 $0.00

Inpatient Facility

E & M - Inpatient

E & M - Outpatient


InpatientM 7464 0 594 0F 3079 463 2500 0

Total $10,543.00 $463.00 $3,094.00 $0.00M 0 0 1404 0F 0 0 0 0

Total $0.00 $0.00 $1,404.00 $0.00M 40557 1129 2627 5478F 0 0 1430 0

Total $40,557.00 $1,129.00 $4,057.00 $5,478.00M 0 0 0 0F 0 0 2500 0

Total $0.00 $0.00 $2,500.00 $0.00M $48,021.00 $1,129.00 $4,625.00 $5,478.00F $3,079.00 $463.00 $6,430.00 $0.00

Total $51,100.00 $1,592.00 $11,055.00 $5,478.00

65-75

Total

AMI without Comorbidity

Age Sex


18-44

45-54

55-64

65-75

Total

Angina with Comorbidity

Age Sex


18-44

45-54

55-64

65-75

Total

Angina without Comorbidity

Age Sex


Inpatient Facility

E & M - Inpatient

E & M - Outpatient



Total $0.00 $0.00 $0.00 $0.00M 0 0 0 0F 0 0 0 0

Total $0.00 $0.00 $0.00 $0.00M 0 0 0 0F 0 0 0 0

Total $0.00 $0.00 $0.00 $0.00M 0 0 0 0F 0 0 0 0

Total $0.00 $0.00 $0.00 $0.00M $0.00 $0.00 $0.00 $0.00F $0.00 $0.00 $0.00 $0.00

Total $0.00 $0.00 $0.00 $0.00

Inpatient Facility

E & M - Inpatient

E & M - Outpatient


InpatientM 59532 2072 1160 1724F 11144 569 1347 0

Total $70,676.00 $2,641.00 $2,507.00 $1,724.00M 46555 2164 7163 15205F 48637 2637 6200 3950

Total $95,192.00 $4,801.00 $13,363.00 $19,155.00M 185699 8459 26477 6280F 193510 7576 24239 1553

Total $379,209.00 $16,035.00 $50,716.00 $7,833.00M 52378 1666 3720 3989F 83887 4301 8207 0

Total $136,265.00 $5,967.00 $11,927.00 $3,989.00M $344,164.00 $14,361.00 $38,520.00 $27,198.00F $337,178.00 $15,083.00 $39,993.00 $5,503.00

Total $681,342.00 $29,444.00 $78,513.00 $32,701.00

Inpatient Facility

E & M - Inpatient

E & M - Outpatient


InpatientM 0 0 205 0F 0 0 300 0

Total $0.00 $0.00 $505.00 $0.00M 0 0 256 0F 0 0 0 0

Total $0.00 $0.00 $256.00 $0.00M 53572 1908 3310 320F 0 0 296 0

Total $53,572.00 $1,908.00 $3,606.00 $320.00

Age Sex

18-44

45-54

55-64

65-75

Total

CAD with Comorbidity

Age Sex


18-44

45-54

55-64

18-44

45-54

55-64

65-75

Total

CAD without Comorbidity

Age Sex


M 0 0 0 0F 0 0 0 0

Total $0.00 $0.00 $0.00 $0.00M $53,572.00 $1,908.00 $3,771.00 $320.00F $0.00 $0.00 $596.00 $0.00

Total $53,572.00 $1,908.00 $4,367.00 $320.00


E & M - Inpatient -

PMPM


PMPM


PMPM

M $1,768.10 $47.27 $41.00 $95.65F $1,487.05 $58.87 $91.15 $102.57

Total $1,627.58 $53.07 $66.08 $99.11M $411.07 $18.11 $72.78 $88.88F $450.34 $24.42 $81.63 $36.57

Total $423.69 $20.13 $75.62 $72.07M $625.59 $27.86 $83.88 $28.13F $1,014.14 $44.30 $110.20 $21.16

Total $793.36 $34.95 $95.24 $25.12M $1,250.45 $48.58 $51.71 $78.94F $780.13 $41.14 $116.27 $0.00

Total $973.79 $44.21 $89.69 $32.50M $707.93 $28.64 $74.97 $53.44F $923.83 $41.83 $104.98 $27.14

Total $801.57 $34.36 $87.99 $42.03

65-75

Total

Cardiovascular Conditions Totals

55-64

65-75

Total

Age Sex


18-44

45-54

Total Male Female Total Male Female Total0 12 0 12 0 0 0

24 12 0 12 0 0 012 12 12 24 0 0 00 12 0 12 0 0 0

36 48 12 60 0 0 0

Total Male Female Total Male Female Total0 24 24 48 12 12 240 120 84 204 12 0 120 336 227 563 36 12 480 60 84 144 0 0 00 540 419 959 60 24 84


24 12 0 12 0 0 012 12 12 24 0 0 00 12 0 12 0 0 0

36 48 12 60 0 0 0

Total Male Female Total Male Female Total0 24 24 48 12 12 240 120 84 204 12 0 120 336 227 563 36 12 480 60 84 144 0 0 00 540 419 959 60 24 84

er Months Without Member Months (AMI With

Comorbidity)Member Months (AMI Without

Comorbidity)

a Without Member Months (CAD With Comorbidity)

Member Months (CAD Without Comorbidity)

ber Months Without Member Months (AMI With

Comorbidity)Member Months (AMI Without

Comorbidity)

a Without Member Months (CAD With Comorbidity)

Member Months (CAD Without Comorbidity)





DischargesED Visits

0 0 0 00 3645 11 6

$0.00 $3,645.00 11 64624 21360 3 10649 6480 0 0

$5,273.00 $27,840.00 3 108026 38267 4 24386 39650 9 16

$12,412.00 $77,917.00 13 180 2614 0 1

1779 9322 2 1$1,779.00 $11,936.00 2 2

$12,650.00 $62,241.00 7 13$6,814.00 $59,097.00 22 23

$19,464.00 $121,338.00 29 36



DischargesED Visits

0 0 0 00 0 0 0

$0.00 $0.00 0 0111 15557 0 8

0 0 0 0$111.00 $15,557.00 0 8

1810 1110 0 00 0 0 0

$1,810.00 $1,110.00 0 00 0 0 00 0 0 0

$0.00 $0.00 0 0$1,921.00 $16,667.00 0 8

$0.00 $0.00 0 0$1,921.00 $16,667.00 0 8



DischargesED Visits

220 491 1 30 0 0 0

$220.00 $491.00 1 30 2134 2 20 0 0 0

$0.00 $2,134.00 2 23907 2395 0 0829 4284 0 1

$4,736.00 $6,679.00 0 1





18 1808 2 20 0 0 0

$18.00 $1,808.00 2 2$4,145.00 $6,828.00 5 7$829.00 $4,284.00 0 1

$4,974.00 $11,112.00 5 8



DischargesED Visits

0 0 0 00 0 0 0

$0.00 $0.00 0 00 0 0 00 0 0 0

$0.00 $0.00 0 00 0 0 00 0 0 0

$0.00 $0.00 0 00 0 0 00 0 0 0

$0.00 $0.00 0 0$0.00 $0.00 0 0$0.00 $0.00 0 0$0.00 $0.00 0 0



DischargesED Visits

1724 2090 1 0780 595 1 7

$2,504.00 $2,685.00 2 718 11153 0 10 0 0 0

$18.00 $11,153.00 0 11034 8754 3 51461 912 0 0

$2,495.00 $9,666.00 3 50 0 0 0

204 4938 0 1$204.00 $4,938.00 0 1

$2,776.00 $21,997.00 4 6$2,445.00 $6,445.00 1 8$5,221.00 $28,442.00 5 14









DischargesED Visits

0 0 0 00 0 0 0

$0.00 $0.00 0 00 0 0 00 0 0 0

$0.00 $0.00 0 00 0 0 00 0 0 0

$0.00 $0.00 0 00 0 0 00 0 0 0

$0.00 $0.00 0 0$0.00 $0.00 0 0$0.00 $0.00 0 0$0.00 $0.00 0 0



DischargesED Visits

36 5402 5 71437 3272 1 1

$1,473.00 $8,674.00 6 86228 30953 4 211024 26350 4 14

$7,252.00 $57,303.00 8 357797 81275 18 33

16958 74735 16 39$24,755.00 $156,010.00 34 72

567 9983 2 118242 24193 6 5

$18,809.00 $34,176.00 8 6$14,628.00 $127,613.00 29 62$37,661.00 $128,550.00 27 59$52,289.00 $256,163.00 56 121



DischargesED Visits

18 2755 0 0591 72 0 2

$609.00 $2,827.00 0 29 1031 0 00 0 0 0

$9.00 $1,031.00 0 037 5562 3 5

2871 305 0 0$2,908.00 $5,867.00 3 5





0 0 0 00 0 0 0

$0.00 $0.00 0 0$64.00 $9,348.00 3 5

$3,462.00 $377.00 0 2$3,526.00 $9,725.00 3 7


PMPM

Pharmacy - PMPM

Inpatient Facility

Discharges/ 1,000

Member Years

ED Visits/1,000

Member Years

$33.30 $178.97 1,400.00 2,000.00$46.80 $126.40 2,600.00 3,200.00$40.05 $152.68 2,000.00 2,600.00$48.20 $360.47 473.68 2,210.53$15.49 $303.98 444.44 1,555.56$37.69 $342.32 464.29 2,000.00$44.86 $272.55 666.67 1,071.43$69.20 $313.02 783.29 1,754.57$55.37 $290.02 717.02 1,366.40$6.96 $171.49 571.43 571.43

$168.54 $320.44 800.00 700.00$102.01 $259.11 705.88 647.06$41.31 $279.33 657.53 1,383.56$76.32 $296.20 894.19 1,663.19$56.49 $286.65 760.18 1,504.85





Male Female Total Male Female18-44 778 922 1,700 778 92245-54 492 728 1,220 492 72855-64 586 527 1,113 586 52765-85 120 108 228 120 108Total 1,976 2,285 4,261 1,976 2,285

Inpatient Facility

E & M - Inpatient

E & M - Outpatient


InpatientM 162181 6654 47283 13662F 35937 1630 59719 3439

Total $198,118.00 $8,284.00 $107,002.00 $17,101.00M 54150 2693 38429 5474F 79877 3046 53922 17426

Total $134,027.00 $5,739.00 $92,351.00 $22,900.00M 131971 2835 36476 17353F 84549 1733 40757 6496

Total $216,520.00 $4,568.00 $77,233.00 $23,849.00M 0 501 9583 0F 0 0 7588 0

Total $0.00 $501.00 $17,171.00 $0.00M $348,302.00 $12,683.00 $131,771.00 $36,489.00F $200,363.00 $6,409.00 $161,986.00 $27,361.00

Total $548,665.00 $19,092.00 $293,757.00 $63,850.00


E & M - Inpatient -

PMPM


PMPM


PMPM

M $208.46 $8.55 $60.78 $17.56F $38.98 $1.77 $64.77 $3.73

Total $116.54 $4.87 $62.94 $10.06M $110.06 $5.47 $78.11 $11.13F $109.72 $4.18 $74.07 $23.94

Total $109.86 $4.70 $75.70 $18.77M $225.21 $4.84 $62.25 $29.61

Relative Resource Use for People With Hypertension (RHY)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)



Age Medical Benefit Member Months Pharmacy Benefit Memb

Age Sex


Uncomplicated Hypertension

Age Sex


18-44

45-54

55-64

65-85

Total

Uncomplicated Hypertension Totals

18-44

45-54

F $160.43 $3.29 $77.34 $12.33Total $194.54 $4.10 $69.39 $21.43

M $0.00 $4.18 $79.86 $0.00F $0.00 $0.00 $70.26 $0.00

Total $0.00 $2.20 $75.31 $0.00M $176.27 $6.42 $66.69 $18.47F $87.69 $2.80 $70.89 $11.97

Total $128.76 $4.48 $68.94 $14.98

55-64

65-85

Total

Total1,7001,2201,113228

4,261



DischargesED Visits

14443 59189 10 8138827 88634 6 160

$53,270.00 $147,823.00 16 24113292 70241 6 3919056 102638 8 54

$32,348.00 $172,879.00 14 9329799 80423 10 3510657 75966 5 30

$40,456.00 $156,389.00 15 652645 10466 0 72245 25375 0 8

$4,890.00 $35,841.00 0 15$60,179.00 $220,319.00 26 162$70,785.00 $292,613.00 19 252

$130,964.00 $512,932.00 45 414


PMPM

Pharmacy - PMPM

Inpatient Facility

Discharges/ 1,000

Member Years

ED Visits/ 1,000

Member Years

$18.56 $76.08 154.24 1,249.36$42.11 $96.13 78.09 2,082.43$31.34 $86.95 112.94 1,701.18$27.02 $142.77 146.34 951.22$26.18 $140.99 131.87 890.11$26.51 $141.70 137.70 914.75$50.85 $137.24 204.78 716.72

ber Months





$20.22 $144.15 113.85 683.11$36.35 $140.51 161.73 700.81$22.04 $87.22 0.00 700.00$20.79 $234.95 0.00 888.89$21.45 $157.20 0.00 789.47$30.45 $111.50 157.89 983.81$30.98 $128.06 99.78 1,323.41$30.74 $120.38 126.73 1,165.92



With Comorbidity 248Without Comorbidity 69

Male Female Total Male Female42-44 48 48 96 12 2445-64 1126 1581 2,707 286 47865-74 108 60 168 24 075+ 0 0 0 0 0

Total 1,282 1,689 2,971 322 502

Inpatient Facility

E & M - Inpatient

E & M - Outpatient


InpatientM 54311 3124 5074 0F 9364 1173 4452 0

Total $63,675.00 $4,297.00 $9,526.00 $0.00M 817816 39733 97540 35448F 962181 55048 156184 55229

Total $1,779,997.00 $94,781.00 $253,724.00 $90,677.00

M 40386 2209 5409 354F 100144 4789 3121 2138

Total $140,530.00 $6,998.00 $8,530.00 $2,492.00M 0 0 0 0F 0 0 0 0

Total $0.00 $0.00 $0.00 $0.00M $912,513.00 $45,066.00 $108,023.00 $35,802.00

F $1,071,689.00 $61,010.00 $163,757.00 $57,367.00

Total $1,984,202.00 $106,076.00 $271,780.00 $93,169.00

Inpatient Facility

E & M - Inpatient

E & M - Outpatient


InpatientM 0 0 330 0F 0 0 442 0

Total $0.00 $0.00 $772.00 $0.00M 189992 9014 13849 2581F 216773 6849 32816 23814

Relative Resource Use for People With COPD (RCO)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Eligible Population

Age

Member Benefit Member Months

Member Months (With Comorbidity) Member Months (Without C

COPD with Comorbidity

Age Sex


42-44

45-64

65-74

75+

Total

COPD without Comorbidity

Age Sex


42-44

45-64

Total $406,765.00 $15,863.00 $46,665.00 $26,395.00M 5096 501 3089 728F 0 0 0 0

Total $5,096.00 $501.00 $3,089.00 $728.00M 0 0 0 0F 0 0 0 0

Total $0.00 $0.00 $0.00 $0.00M $195,088.00 $9,515.00 $17,268.00 $3,309.00F $216,773.00 $6,849.00 $33,258.00 $23,814.00

Total $411,861.00 $16,364.00 $50,526.00 $27,123.00


E & M - Inpatient -

PMPM


PMPM


PMPM

M $905.18 $52.07 $90.07 $0.00F $130.06 $16.29 $67.97 $0.00

Total $482.39 $32.55 $78.02 $0.00M $713.75 $34.52 $78.89 $26.93F $572.59 $30.06 $91.79 $38.39

Total $630.01 $31.88 $86.54 $33.73M $344.56 $20.53 $64.38 $8.20F $1,669.07 $79.82 $52.02 $35.63

Total $758.47 $39.06 $60.52 $16.77M NA NA NA NAF NA NA NA NA

Total NA NA NA NAM $690.52 $34.03 $78.11 $24.38F $588.07 $30.97 $89.92 $37.05

Total $631.37 $32.26 $84.93 $31.70

42-44

45-64

65-74

75+

Total

COPD Totals


65-74

75+

Total

Age Sex


764 1126 1581 2,707 286 478 76424 108 60 168 24 0 240 0 0 0 0 0 0

824 1,282 1,689 2,971 322 502 824



DischargesED Visits

522 10084 10 7383 6713 2 20

$905.00 $16,797.00 12 2754597 342059 70 19793476 517232 100 372

$148,073.00 $859,291.00 170 569

1503 26576 2 128198 19571 5 13

$9,701.00 $46,147.00 7 250 0 0 00 0 0 0

$0.00 $0.00 0 0$56,622.00 $378,719.00 82 216

$102,057.00 $543,516.00 107 405

$158,679.00 $922,235.00 189 621



DischargesED Visits

0 683 0 127 470 0 1

$27.00 $1,153.00 0 23894 39602 8 24

15752 57485 13 49


Comorbidity) Member Months (With Comorbidity) Member Months (Without Comorbidity)





$19,646.00 $97,087.00 21 739 1250 1 20 0 0 0

$9.00 $1,250.00 1 20 0 0 00 0 0 0

$0.00 $0.00 0 0$3,903.00 $41,535.00 9 27

$15,779.00 $57,955.00 13 50$19,682.00 $99,490.00 22 77


PMPM

Pharmacy - PMPM

Inpatient Facility

Discharges/ 1,000

Member Years

ED Visits/ 1,000

Member Years

$8.70 $179.45 2,000.00 1,600.00$5.69 $99.76 333.33 3,500.00$7.06 $135.98 1,090.91 2,636.36

$41.42 $270.30 662.89 1,878.19$53.05 $279.12 658.57 2,453.62$48.32 $275.53 660.33 2,219.53$11.45 $210.80 272.73 1,272.73

$136.63 $326.18 1,000.00 2,600.00$50.57 $246.86 500.00 1,687.50

NA NA NA NANA NA NA NANA NA NA NA

$37.73 $262.00 680.80 1,817.96$53.78 $274.52 657.23 2,492.01$47.00 $269.23 667.19 2,207.11

Total Service Frequency by Service Category, Age,

and Gender

Age, and Gender

Number PercentFamily Medicine 415 271 65.30%Internal Medicine 337 256 75.96%

OB/GYN physicians 126 96 76.19%Pediatricians 169 132 78.11%Geriatricians 14 11 78.57%

Other physician specialists 622 524 84.24%

Board Certification (BCR)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Type of Physician Number of Physicians

Board Certification

AgeMale

Member Months

Female Member Months

Total Member Months

<1 25590 23974 49,5641-4 93706 86944 180,6505-9 95351 90812 186,163

10-14 76660 72830 149,49015-17 38787 40741 79,52818-19 12082 18071 30,153

0-19 Subtotal 342,176 333,372 675,5480-19 Subtotal: % 89.14% 74.75% 81.41%

20-24 5635 28493 34,12825-29 5919 26304 32,22330-34 4661 16728 21,38935-39 4611 11721 16,33240-44 4262 8043 12,305


45-49 4433 6293 10,72650-54 4508 5486 9,99455-59 3657 4546 8,20360-64 3355 3933 7,288


65-69 416 724 1,14070-74 109 217 32675-79 53 77 13080-84 37 19 5685-89 12 26 38>=90 0 1 1

>=65 Subtotal 627 1,064 1,691>=65 Subtotal: % 0.16% 0.24% 0.20%

Age Unknown 0 0 0Total 383,844 445,983 829,827

Enrollment by Product Line: Total (ENPA)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

AgeMale

Member Months


Total Member Months

<1 NR NR NR1-4 NR NR NR5-9 NR NR NR

10-14 NR NR NR15-17 NR NR NR18-19 NR NR NR

0-19 Subtotal NR NR NR0-19 Subtotal: % NR NR NR

20-24 NR NR NR25-29 NR NR NR30-34 NR NR NR35-39 NR NR NR40-44 NR NR NR


45-49 NR NR NR50-54 NR NR NR55-59 NR NR NR60-64 NR NR NR


65-69 NR NR NR70-74 NR NR NR75-79 NR NR NR80-84 NR NR NR85-89 NR NR NR>=90 NR NR NR

>=65 Subtotal NR NR NR>=65 Subtotal: % NR NR NR

Age Unknown NR NR NRTotal NR NR NR

Enrollment by Product Line: Dual Eligibles (ENPB)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

AgeMale

Member Months


Total Member Months











Enrollment by Product Line: Disabled (ENPC)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

AgeMale

Member Months


Total Member Months











Enrollment by Product Line: Other (ENPD)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

State NumberAlabama 0Alaska 0Arizona 12

Arkansas 0California 0Colorado 1

Connecticut 0Delaware 0

District of Columbia 0Florida 2Georgia 0Hawaii 0Idaho 0Illinois 0Indiana 0

Iowa 0Kansas 0

Kentucky 0Louisiana 0

Maine 0Maryland 0

Massachusetts 0Michigan 0

Minnesota 3Mississippi 0

Missouri 0Montana 0Nebraska 1Nevada 0

New Hampshire 0New Jersey 0New Mexico 71877

New York 0North Carolina 0North Dakota 0

Ohio 0Oklahoma 0

Oregon 0Pennsylvania 0Rhode Island 0

South Carolina 0South Dakota 0

Tennessee 0Texas 84Utah 1

Vermont 0Virginia 1

Washington 0West Virginia 0

Wisconsin 0Wyoming 0

Enrollment by State (EBS)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

American Samoa 0Federated States of Micronesia 0

Guam 0Commonwealth of Northern Marianas 0

Puerto Rico 0Virgin Islands 0

Other 3TOTAL 71,985

Category ValueTotal unduplicated membership during

the measurement year 88822

Data Source Other

Number Percentage Number PercentageM 0 0.00% 8278 9.32%F 0 0.00% 10457 11.77%

Total 0 0.00% 18,735 21.09%M 0 0.00% 1019 1.15%F 0 0.00% 1166 1.31%

Total 0 0.00% 2,185 2.46%M 0 0.00% 0 0.00%F 0 0.00% 0 0.00%

Total 0 0.00% 0 0.00%M 0 0.00% 0 0.00%F 0 0.00% 0 0.00%

Total 0 0.00% 0 0.00%M 0 0.00% 0 0.00%F 0 0.00% 0 0.00%

Total 0 0.00% 0 0.00%M 0 0.00% 0 0.00%F 0 0.00% 0 0.00%

Total 0 0.00% 0 0.00%M 0 0.00% 0 0.00%F 0 0.00% 0 0.00%

Total 0 0.00% 0 0.00%M 28770 32.39% 0 0.00%F 34799 39.18% 0 0.00%

Total 63,569 71.57% 0 0.00%M 28,770 32.39% 9,297 10.47%F 34,799 39.18% 11,623 13.09%

Total 63,569 71.57% 20,920 23.55%

Measure PercentagePercentage of plan members with known

race information 25.69%

Percentage of plan members with known ethnicity information 95.12%

Race/Ethnicity Diversity of Membership (RDM)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Eligible Population

Race SexHispanic or Latino (any

race) Not Hispanic or Latino

Two or More Races

Unknown

Total

Totals

White

Black or African American

American-Indian and Alaska Native

Asian

Native Hawaiian and Other Pacific Islanders

Some Other Race

Number Percentage Number Percentage0 0.00% 8,278 9.32%0 0.00% 10,457 11.77%0 0.00% 18,735 21.09%0 0.00% 1,019 1.15%0 0.00% 1,166 1.31%0 0.00% 2,185 2.46%

661 0.74% 661 0.74%692 0.78% 692 0.78%

1,353 1.52% 1,353 1.52%271 0.31% 271 0.31%275 0.31% 275 0.31%546 0.61% 546 0.61%

0 0.00% 0 0.00%0 0.00% 0 0.00%0 0.00% 0 0.00%0 0.00% 0 0.00%0 0.00% 0 0.00%0 0.00% 0 0.00%0 0.00% 0 0.00%0 0.00% 0 0.00%0 0.00% 0 0.00%

1331 1.50% 30,101 33.89%1103 1.24% 35,902 40.42%2,434 2.74% 66,003 74.31%2,263 2.55% 40,330 45.41%2,070 2.33% 48,492 54.59%4,333 4.88% 88,822 100.00%

Unknown Ethnicity Total

Category ValueTotal unduplicated membership during

the measurement year: 88822

Data Source Other

Demand for Language Interpretation Services Sex Number Percentage

M 0 0.00%F 0 0.00%

Total 0 0.00%M 0 0.00%F 0 0.00%

Total 0 0.00%M 40330 45.41%F 48492 54.59%

Total 88,822 100.00%M 40,330 45.41%F 48,492 54.59%

Total 88,822 100.00%0.00%

Spoken Language at Home Sex Number PercentageM 0 0.00%F 0 0.00%

Total 0 0.00%M 0 0.00%F 0 0.00%

Total 0 0.00%M 0 0.00%F 0 0.00%

Total 0 0.00%M 0 0.00%F 0 0.00%

Total 0 0.00%M 0 0.00%F 0 0.00%

Total 0 0.00%M 40330 45.41%F 48492 54.59%

Total 88,822 100.00%M 40,330 45.41%F 48,492 54.59%

Total 88,822 100.00%0.00%

Language Diversity of Membership (LDM)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Eligible Population

Demand for Language Interpretation Services

Need/want an interpreter? Yes

Need/want an interpreter? No

Need/want an interpreter? Unknown

Total

Percentage of members with known interpretation needsSpoken Language at Home

Unknown

Total

Percentage of members with known spoken language

English

Spanish (or Spanish Creole)

Other Indo-European Languages (e.g., French or French Creole, Italian,

Portuguese or Portuguese Creole, Asian and Pacific Island Languages

(e.g., Chinese, Japanese, Korean, Mon-Khmer, Cambodian, Miao, Hmong, Thai,

Other Languages (e.g., Navajo, Other Native North American languages, Hungarian, Arabic, Hebrew, African

Measurement Year 2009Weeks of Pregnancy Number Percentage

< 0 weeks 794 30.42% 1-12 weeks 173 6.63%

13-27 weeks 1063 40.73% 28 or more weeks 448 17.16%

Unknown 132 5.06%Total 2,610 100.00%

Weeks of Pregnancy at Time of Enrollment in MCO (WOP)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

Measurement Year

Product/Product LineTotal

Number of Members*

HMO (Total) 71,985Medicaid 71985

Commercial 0Medicare (cost or risk) 0

Other 0PPO (Total) 0

Medicaid 0Commercial 0

Medicare (cost or risk) 0Other 0

POS (Total) 0Medicaid 0


Other 0FFS (Total) 0Medicaid 0


Other 0Total 71,985

Total Membership (TLM)Molina Healthcare of New Mexico (Org ID: 955, SubID: 4112, Medicaid, Spec Area: None, Spec Proj: None)

* Total number of members in each category as of December 31 of the measurement year.

Audit Review Table - NM Human Services · 2014-01-08 · Molina Healthcare of New Mexico (Org ID:...

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